Anatomical model controlling

ABSTRACT

Devices, systems, and methods of the present disclosure are directed to facilitating control of a graphical user interface associated with performing a medical procedure. Inputs can be received from a plurality of input devices interacting with respective sets of input options displayed on respective portions of the graphical user interface. One of the input devices can be operable by a physician, during a medical procedure, to navigate a set of input options to modify a graphical representation of at least one of a medical device and an anatomic structure displayed on the graphical user interface.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit under 35 U.S.C. § 119(e) of U.S.Prov. App. No. 62/335,120, filed May 12, 2016, U.S. Prov. App. No.62/336,143, filed May 13, 2016, U.S. Prov. App. No. 62/338,210, filedMay 18, 2016, U.S. Prov. App. No. 62/384,291, filed Sep. 7, 2016, U.S.Prov. App. No. 62/410,022, filed Oct. 19, 2016, and U.S. Prov. App. No.62/463,870, filed Feb. 27, 2017, with the entire contents of each ofthese applications hereby incorporated herein by reference.

This application is also related to the following commonly-owned U.S.patent application filed on even date herewith and having AttorneyDocket Number AFRA-0007-P01, and entitled “THREE-DIMENSIONAL CARDIACREPRESENTATION,” the entire contents of which are hereby incorporatedherein by reference.

BACKGROUND

Three-dimensional models are sometimes used to assist in the placementor use of a device when such placement or use is not easily observableor practical. For example, in medical procedures, three-dimensionalmodels presented on a graphical user interface are used to assist in theplacement and use of medical devices as part of diagnosis or treatmentof patients. An example of such a medical procedure carried out with theassistance of a three-dimensional model presented on a graphical userinterface is the use of a catheter for radio frequency (“RF”) ablationto terminate certain arrhythmias in the heart.

SUMMARY

Devices, systems, and methods of the present disclosure facilitatecontrol of a graphical user interface by a physician during a medicalprocedure, such as a procedure in which the physician is maneuvering acatheter in a hollow anatomic structure (e.g., a heart cavity). Forexample, using the devices, systems, and methods of the presentdisclosure, a variety of options related to the medical procedure can bepresented to the physician during the medical procedure by presentingsubsets of actions to the physician on the graphical user interface on astate-dependent basis, with the state at any given time depending on thecontext of the action being performed by the physician at the giventime. The presentation of subsets of actions to the physician on astate-dependent basis can, for example, facilitate control of thegraphical user interface by the physician using an input device withonly a few input sources (e.g., buttons).

As compared to an interface requiring a keyboard and a mouse, thesimplified input interface associated with the devices, systems, andmethods of the present disclosure can improve the ability of thephysician to manipulate the graphical user interface, of a graphicalrepresentation of the hollow anatomic structure, or both while thephysician is also manipulating the catheter. Additionally, oralternatively, the devices, systems, and methods of the presentdisclosure can facilitate control of the graphical user interface and/orthe graphical representation of the hollow anatomic structure fromwithin the sterile field and, optionally, without the assistance of aperson outside of the sterile field. Such autonomy of control by thephysician can, for example, simplify medical procedures by reducing, oreven eliminating, the need for the physician to communicate with aperson outside of the sterile field to achieve desired control over thegraphical user interface and, further or instead, control over thegraphical representation of the hollow anatomic structure.

According to one aspect, a method includes receiving a signal indicativeof location of a cardiac catheter in a cavity of a patient's heart,displaying, on a first portion of a graphical user interface, agraphical representation of the cavity of the patient's heart, thegraphical representation based on the received location signal from thecardiac catheter, receiving, from a first input device, a first inputcommand based on a first set of input options displayed on the firstportion of the graphical user interface, receiving, from a second inputdevice, a second input command based on a second set of input optionsdisplayed on a second portion of the graphical user interface, and,based on the first input command and the second input command, modifyingthe graphical representation in the first portion of the graphical userinterface.

In certain implementations, modifying the graphical representation caninclude adjusting the displayed graphical representation according to anorder in which the first input command and the second input command arereceived.

In some implementations, at least some of the second set of inputoptions can be the same as some of the first set of input options.

In certain implementations, receiving the first input command caninclude receiving the first input command along a first communicationchannel and receiving the second input command can include receiving thesecond input command along a second communication channel, eachcommunication channel dedicated to the respective portion of thegraphical user interface.

In some implementations, the method can further include receivingnavigation commands for moving, within the second portion of thegraphical user interface, between the options in the second set of inputoptions. For example, the second set of input options represented on thesecond portion of the graphical user interface can correspond to acurrent state of a state machine having a plurality of states. Incertain instances, the second input command or at least one of thenavigation commands can change a current state of a state machine.Additionally, or alternatively, in each of the plurality of states, thesecond input command or at least one of the navigation commands canchange a top-level state of the current state of the state machine. Forexample, the navigation commands can include commands to change thetop-level state of the current state of the state machine between abuild state, a view state, and a tag state.

In certain implementations, when the current state is the build state,representing the current state in the second portion of the graphicaluser interface can include representing input command options to startand to stop building a three-dimensional representation, shown in thefirst portion of the graphical user interface, of the cavity of thepatient's heart. Additionally, or alternatively, when the current stateis the view state, representing the current state in the second portionof the graphical user interface includes representing options to turn anautomatic view control on and off. Further, or instead, when the currentstate is the tag state, representing the current state in the secondportion of the graphical user interface can include a selection ofidentifiers corresponding to anatomic features of the heart cavity.

In some implementations, the navigation commands can include discretedirection commands. For example, the discrete direction commands caninclude commands for left, right, up, and down navigation in the secondportion of the graphical user interface.

In certain implementations, at least one of the navigation commands canscroll through the second set of options displayed as an infinite wheel.

In some implementations, the method can further include detectingreceipt of an initial command, the initial command being one of thesecond input command or one of the navigation commands, and, based onthe detected receipt of the initial command, changing one or moredisplay features of the second portion of the graphical user interface.For example, changing the one or more display features of the secondportion of the graphical user interface can include displaying, in thesecond portion of the graphical user interface, additional input optionsof the second set of input options. Additionally, or alternatively,changing one or more display features of the second portion of thegraphical user interface can include changing the one or more displayfeatures of the second portion, relative to the first portion of thegraphical user interface, between a baseline configuration and modifiedconfiguration. By way of example, changing the one or more displayfeatures of the second portion of the graphical user interface relativeto the first portion of the graphical user interface between a baselineconfiguration and a modified configuration can include changing a sizeof the second portion of the graphical user interface relative to a sizeof the first portion of the graphical user interface. Also, or instead,changing the one or more display features of the second portion of thegraphical user interface relative to the first portion of the graphicaluser interface can include changing an opacity of the second portion ofthe graphical user interface relative to an opacity of the first portionof the graphical user interface. By way of further or alternativeexample, changing the one or more display features of the second portionof the graphical user interface relative to the first portion of thegraphical user interface can include changing a position of the secondportion of the graphical user interface relative to a position of thefirst portion of the graphical user interface. As still a further oralternative example, changing the one or more display features of thesecond portion of the graphical user interface relative to the firstportion of the graphical user interface between the baselineconfiguration and the modified configuration can include changing thesecond portion of the graphical user interface from the modifiedconfiguration to the baseline configuration if a time between receipt ofa first one of the input commands and receipt of a second one of theinput commands exceeds a predetermined inactivity threshold period.Additionally, or alternatively, changing the one or more displayfeatures of the second portion of the graphical user interface relativeto the first portion of the graphical user interface between thebaseline configuration and the modified configuration can includechanging the second portion of the graphical user interface from themodified configuration to the baseline configuration based on a receivedinput command of the second set of input commands.

In certain implementations, the first portion can be viewable on thegraphical user interface at the same time that the second portion can beviewable on the graphical user interface. In some instances,modification of the displayed graphical representation can includeadjusting an orientation of a displayed view of the graphicalrepresentation of the heart cavity of the patient. For example,adjusting the orientation of the displayed view of the graphicalrepresentation of the heart cavity of the patient can include rotatingthe graphical representation of the heart cavity about an axis.

In some implementations, modifying the displayed graphicalrepresentation in the first portion of the graphical user interface caninclude modifying a pose of the graphical representation in the firstportion of the graphical user interface.

In certain implementations, the second input command can include adiscrete selection command.

In some implementations, receiving the second input command can includereceiving a wireless input command.

In certain implementations, the second input device can be a remotedevice and receiving the second input command can include receiving aninput command from the remote device.

In some implementations, the second input device can be releasablycoupled to a handle of the cardiac catheter.

According to another aspect, a method includes receiving as signalindicative of a location of a catheter tip in a cavity of a patient'sheart, displaying, on a graphical user interface, a graphicalrepresentation of the location of the catheter tip in the cavity of thepatient's heart, receiving, from a first input device, a first inputcommand responsive to a first set of input options displayed on thegraphical user interface, receiving, from a second input device separatefrom the first input device, navigation commands and a second inputcommand, the navigation commands for moving through a second set ofinput options, and the second input command responsive to the second setof input options displayed on the graphical user interface, and based onthe first input command and the second input command, modifying thedisplayed graphical representation.

In some implementations, modifying the graphical representation caninclude modifying the graphical representation according to an order inwhich the first input command and the second input command are received.

In certain implementations, the method can further include displayingthe first set of input options on a first portion of the graphical userinterface, and displaying the second set of input options on a secondportion of the graphical user interface.

In some implementations, the second set of input options can includeavailable transitions of a state machine. Additionally, oralternatively, the second set of input options displayed on thegraphical user interface are based on a current state of the statemachine.

In certain implementations, receiving the navigation commands caninclude receiving discrete directional commands for moving through thesecond set of input options. For example, the discrete directionalcommands can correspond to right, left, up, and down navigation throughthe second set of input options.

In certain implementations, receiving the navigation commands caninclude receiving an analog command for navigating through the secondset of input options.

In some implementations, the second set of input options can be arrangedin an infinite wheel and receiving the navigation commands can includereceiving a scroll command for moving through states of the infinitewheel.

In certain implementations, the method can further include modifying,based on the received navigation commands, one or more display featuresof the second set of input options between a baseline configuration anda modified configuration. For example, a size of the displayed secondset of input options to relative to a size of the displayed first set ofinput options can be greater in the modified configuration than in thebaseline configuration. Additionally, or alternatively, an opacity ofthe displayed second set of input options relative to an opacity of thefirst set of input options can be greater in the modified configurationthan in the baseline configuration. Further, or instead, a position ofthe second set of input options relative to the first set of inputoptions on the graphical user interface can be different in the modifiedconfiguration than in the baseline configuration.

In some implementations, modifying the one or more display features ofthe second set of input options between a baseline configuration and amodified configuration can include changing the second set of inputoptions from the modified configuration to the baseline configuration ifa time between receipt of a first input command and receipt of a secondinput command exceeds a predetermined inactivity threshold period.

In certain implementations, modifying the one or more display featuresof the second set of input options between a baseline configuration anda modified configuration can include changing the second set of inputoptions from the baseline configuration to the modified configuration ifan input command of the second set of input options is received.

According to still another aspect, a non-transitory, computer-readablestorage medium has stored thereon computer executable instructions forcausing one or more processors to perform operations including receivinga signal indicative of a location of a catheter tip in a cavity of apatient's heart, displaying, on a graphical user interface, a graphicalrepresentation of the location of the catheter tip in the cavity of thepatient's heart, receiving, from a first input device, a first inputcommand responsive to a first set of input options displayed on thegraphical user interface, receiving, from a second input device separatefrom the first input device, navigation commands and a second inputcommand, the navigation commands for moving through a second set ofinput options, and the second input command responsive to the second setof input options displayed on the graphical user interface, and, basedon the first input command and the second input command, modifying thegraphical representation on the graphical user interface.

In some implementations, the operations can further include displayingthe first set of input options on a first portion of the graphical userinterface, and displaying the second set of input options on a secondportion of the graphical user interface.

In certain implementations, receiving the navigation commands caninclude receiving an analog command for navigating through the secondset of input options.

In some implementations, the operations can further include modifying,based on the received navigation commands, one or more display featuresof the second set of input options between a baseline configuration to amodified configuration.

According to still another aspect, a catheter includes a catheter shafthaving a proximal end region and a distal end region, a handle portioncoupled to the proximal end region of the catheter shaft, anarticulation controller supported on the handle portion, thearticulation controller in mechanical communication with the cathetershaft to modify a position of the distal end region of the cathetershaft, and a graphical user interface (GUI) controller coupled to thehandle portion and disposed relative to the articulation controlleralong the handle portion such that a user can maintain the distal endregion of the catheter in place while manipulating the GUI controller.

In certain implementations, the GUI controller can be configured forcommunication with a graphical representation of at least a portion ofthe catheter on a GUI.

In some implementations, the GUI controller can be disposed relative tothe articulation controller along the handle portion such that the usercan manipulate the GUI controller and the articulation controllerthrough one-handed operation.

In certain implementations, the GUI controller can be disposed relativeto the articulation controller along the handle portion such that theuser can manipulate the GUI controller and the articulation controllerusing the same grip of the handle portion.

In some implementations, the GUI controller can be releasably coupled tothe handle portion.

In some implementations, the GUI controller can be rotatably coupled tothe handle portion such that the GUI controller is rotatable about anaxis defined by the catheter shaft. For example, the GUI controller canbe rotatable about 180 degrees of a circumference of the catheter shaft.Additionally, or alternatively, the GUI controller can be freelyrotatable about a circumference of the catheter shaft.

In certain implementations, the GUI controller can include discretenavigation inputs. For example, the navigation inputs can include right,left, up, and down navigation inputs.

In some implementations, the GUI controller can include a capacitivetouch portion.

In certain implementations, the GUI controller can be coupled to thehandle portion distal to the articulation controller.

In some implementations, the GUI controller can include one or moreinputs and the articulation controller can be moveable along a planesubstantially perpendicular to a direction of movement of the one ormore inputs.

In certain implementations, the GUI controller can include anorientation feature extending from a surface of the GUI controller toprovide tactile feedback to the user regarding a position of the user'shand with respect to the GUI controller.

In some implementations, the GUI controller is sterilizable. Forexample, the GUI controller can be formed of components compatible withone or more of the following sterilization techniques: ethylene oxidesterilization, autoclave sterilization, gamma radiation, gas-plasmasterilization.

In certain implementations, the catheter can further include at leastone electrode mechanically coupled to the distal end region of thecatheter shaft. For example, the at least one electrode can be disposedalong an expandable element coupled to the distal end region of thecatheter shaft.

In some implementations, the GUI controller can be configured forcommunication with a remote graphical user interface. For example, theGUI controller can include a transmitter. Additionally, oralternatively, the GUI controller includes a wireless transmitter.

According to another aspect, a system includes a graphical userinterface, one or more processors, a first input device in communicationwith the one or more processors, a second input device separate from thefirst input device, the second input device in communication with theone or more processors, and a non-transitory, computer-readable storagemedium having stored thereon computer executable instructions forcausing one or more processors to perform operations including receivinga signal indicative of a location of a catheter tip in a cavity of apatient's heart, displaying, on the graphical user interface, agraphical representation of the cavity of the patient's heart,receiving, from the first input device, a first input command responsiveto a first set of input options displayed on the graphical userinterface, receiving, from the second input device separate from thefirst input device, navigation commands and a second input command, thenavigation commands for moving through a second set of input options,and the second input command responsive to the second set of inputoptions displayed on the graphical user interface, and, based on thefirst input command and the second input command, modifying thedisplayed graphical representation.

According to still another aspect, a remote communication deviceincludes a user interface including one or more inputs, a transmitter incommunication with the user interface to send one or more controlcommands to a remote processor, and a housing carrying the userinterface and the transmitter, the housing securable to an outercircumference of a catheter shaft with the user interface at leastpartially constrained in at least one direction relative to the cathetershaft.

In certain implementations, the transmitter includes a wirelesstransmitter.

In some implementations, with the housing secured to the outercircumference of the catheter shaft, the user interface can be at leastpartially constrained in a radial direction relative to the cathetershaft. Additionally, or alternatively, with the housing secured to theouter circumference of the catheter shaft, the user interface can bemovable less than about 1 cm in the radial direction relative to thecatheter shaft. Further, or instead, with the housing secured to theouter circumference of the catheter shaft, the user interface can beentirely constrained in the radial direction relative to the cathetershaft. Still further, or instead, with the housing secured to the outercircumference of the catheter shaft, the one or more inputs of the userinterface can be depressible in a direction parallel to the at least onepartially constrained direction of the user interface.

In certain implementations, with the housing secured to the outercircumference of the catheter shaft, the user interface can be movablealong an axis defined by the catheter shaft.

In some implementations, with the housing secured to the outercircumference of the catheter shaft, the user interface can be rotatableabout the catheter shaft.

In certain implementations, with the housing secured to the outercircumference of the catheter shaft, the user interface can be rotatableabout an axis of rotation coaxial with an axis defined by the cathetershaft. For example, the user interface can be rotatable 360 degreesabout the catheter shaft. Additionally, or alternatively, the one ormore inputs can be depressible in a direction transverse to the axis ofrotation of the user interface.

In some implementations, with the housing secured to the outercircumference of the catheter shaft, the user interface can be rotatablerelative to a handle coupled to the catheter shaft.

In certain implementations, the housing can define a recess positionableabout at least a portion of the outer circumference of the cathetershaft. For example, the portion of the housing defining the recess caninclude a first section and a second section releasably engageable withthe first section to define the recess. For example, the second sectioncan be releasably engageable with the first section through aninterference fit. Additionally, or alternatively, the first section ofthe housing can include a first material, the second section of thehousing can include a second material magnetically attracted to thefirst material, and the first section and the second section of thehousing can be releasably engageable to one another through a magneticforce between the first material and the second material. Further, orinstead, the first section and the second section can each define aportion of the recess. By way of example, the first section and thesecond section can each define substantially half of the recess. As afurther or alternative example, the portion of the housing defining therecess can further include a hinge disposed between the first sectionand the second section, the hinge pivotable to move the first sectionand the second section into releasable engagement with one another.

In some implementations, the housing can include a clip positionableabout at least a portion of the outer circumference of the cathetershaft.

In certain implementations, the housing can be securable in a fixedaxial position relative to the catheter shaft. For example, the housingcan be securable in the fixed axial position relative to the cathetershaft through an interference fit between the outer circumference of thecatheter shaft and the housing.

In some implementations, the one or more inputs can include a capacitivetouch portion.

In certain implementations, the housing can be formed of materialcompatible with sterilization.

In some implementations, the remote communication device can furtherinclude a cover enclosing the housing and the user interface, the coverremovable from the housing and the user interface, and the cover formedof material compatible with one or more of the following sterilizationtechniques: ethylene oxide sterilization, autoclave sterilization, gammaradiation, gas-plasma sterilization.

In certain implementations, the housing can define a volume and thetransmitter is disposed within the volume. For example, the one or moreinputs can be at least partially disposed outside of the volume. By wayof further or alternative example, the volume can be substantiallyresistant to fluid ingress.

In some implementations, the remote communication device can furtherinclude a power source in communication with the transmitter, the powersource carried by the housing. The power source can be, for example,releasably coupled to the housing.

In certain implementations, the remote communication device can furtherinclude a processor carried by the housing, the processor incommunication with the user interface and the transmitter.

According to still another aspect, a method includes positioning aremote communication device about shaft of a catheter, the shaft havinga proximal end region coupled to a handle and a distal end regioncoupled to an electrode, and securing the remote communication device toan outer circumference of the shaft, along the proximal end region ofthe shaft, the remote communication device including a housing, a userinterface, a transmitter (e.g., a wireless transmitter) in electricalcommunication with the user interface to send one or more controlcommands to a remote processor, the housing carrying the user interfaceand the transmitter, wherein the user interface includes one or moreinputs and, with the remote communication device secured to the outercircumference of the shaft, the user interface is at least partiallyconstrained in at least one direction relative to the shaft.

In some implementations, the remote communication device can be securedto the outer circumference of the shaft, the user interface can be atleast partially constrained in a radial direction relative to the shaft.For example, with the remote communication device secured to the outercircumference of the shaft, the user interface can be movable less thanabout 1 cm in the radial direction relative to the shaft. Further, orinstead, with the remote communication device secured to the outercircumference of the shaft, the user interface can be entirelyconstrained in the radial direction relative to the shaft.

In certain implementations, with the remote communication device securedto the outer circumference of the catheter shaft, the one or more inputsof the user interface can be depressible in a direction parallel to theat least one partially constrained direction of the user interface.

In some implementations, with the remote communication device secured tothe outer circumference of the catheter shaft, the user interface can bemovable along an axis defined by the shaft.

In certain implementations, the user interface can be rotatable about anaxis of rotation coaxial with an axis defined by the shaft. For example,the user interface can be rotatable 360 degrees about the axis ofrotation.

In certain implementations, the one or more inputs can be depressible ina direction transverse to the axis of rotation of the user interface.

In some implementations, the user interface can be rotatable relative tothe handle coupled to the shaft.

In certain implementations, the housing can define a recess, andsecuring the remote communication device to the proximal end region ofthe shaft can include positioning the recess about at least a portion ofthe outer circumference of the shaft. For example, the the portion ofthe housing defining the recess can include a first section and a secondsection, and securing the remote communication device to the proximalend region of the shaft can include coupling the first section and thesecond section to one another about the proximal end region of theshaft.

In some implementations, the housing can be secured to the proximal endregion of the shaft with the housing extending distal to the handle. Forexample, the housing can be secured to the proximal end region of theshaft such that the housing is adjacent to the handle. As a morespecific example, the housing can be mechanically coupled to the handle.

In certain implementations, the method can further include pressing theone or more inputs to generate one or more control commands based on theone or more inputs. Additionally, or alternatively, the method canfurther include wirelessly transmitting one or more control commands toa processor remote from the remote communication device.

According to yet another aspect, a system includes a catheter, acatheter interface unit, and a remote communication device. The catheterincludes a handle, a tip portion, a shaft having a proximal end regionand a distal end region, the proximal end region coupled to the handle,and the distal end region coupled to the tip portion. The catheterinterface unit includes a processing unit and a graphical userinterface. The remote communication device is coupled to the proximalend region of the shaft of the catheter, the remote communication deviceincluding a user interface and a wireless transmitter in communicationwith the user interface to send one or more control commands to theprocessing unit of the catheter interface unit, the one or more controlcommands corresponding to a set of input options displayed on thegraphical user interface.

In certain implementations, the distal end region of the shaft can bedirectly coupled to the tip portion.

In some implementations, movement of the user interface can beconstrained in at least one direction with respect to the shaft of thecatheter and the one or more inputs of the user interface aredepressible in a direction parallel to the at least one constraineddirection of the user interface.

In certain implementations, the remote communication device can be atleast partially constrained in a radial direction relative to the shaft.For example, the user interface can be movable less than about 1 cm inthe radial direction relative to the shaft. For example, the userinterface can be entirely constrained in the radial direction relativeto the shaft.

In some implementations, the user interface can be movable along an axisdefined by the shaft of the catheter.

In certain implementations, the user interface can be rotatable about anaxis defined by the shaft of the catheter. For example, the userinterface can be rotatable relative to the handle.

In some implementations, the remote communication device can be coupledto the proximal end region of the shaft of the catheter at a fixed axialposition of the shaft.

In certain implementations, the remote communication device can furtherinclude a housing, a portion of the housing defining a recess extendingcircumferentially about an outer surface of the shaft of the catheter.For example, the remote communication device can be coupled to theproximal end region of the shaft through an interference fit between theportion of the housing defining the recess and the proximal end regionof the shaft of the catheter.

In some implementations, the remote communication device can bereleasably coupled to the proximal end region of the shaft of thecatheter.

In certain implementations, the catheter can further include anarticulation controller supported on the handle, the articulationcontroller in mechanical communication with the shaft of the catheter tomodify a position of the distal end region of the shaft. For example,the remote communication device can be distal to the articulationcontroller.

In some implementations, the remote communication device can beelectrically and fluidically isolated from the handle and from the shaftof the catheter.

In certain implementations, the one or more inputs of the user interfacecan be positioned relative to the shaft of the catheter such that theone or more inputs are manipulatable by a hand of the user while thesame hand of the user applies an axial force to the shaft.

In some implementations, the one or more inputs of the user interfacecan be positioned relative to the shaft of the catheter such that theone or more inputs are manipulatable by a hand of the user while thesame hand of the user applies torque to the handle of the catheter.

Embodiments can include one or more of the following advantages.

In certain implementations, the graphical representation of the cavityof the patient's heart can be modified based on input commands receivedfrom the first input device and from the second input device. Thus,control of the graphical representation of the cavity can beadvantageously split between two users. As compared to systemscontrollable by only a single user, the divided control provided by thefirst input device and the second input device can facilitate receivingdirect input from the physician, which can result in more efficientmodification of the graphical representation. Additionally, oralternatively, because the graphical representation can also becontrolled by a technician operating the first input device,functionality associated with complex manipulation and/or modificationof the graphical representation can be retained.

In some implementations, the second set of input options, represented onthe second portion of the graphical user interface and interacted withby the second input device, can correspond to a current state of a statemachine having a plurality of states. Because the state of the statemachine changes dynamically according to a given set of eventsassociated with the medical procedure and/or inputs from the secondinput device, robust functionality can be provided to the physicianthrough relatively few inputs on the second input device. Suchrelatively few inputs on the second input device can be useful, forexample, for facilitating one-handed operation of the second inputdevice. Additionally, or alternatively, the relatively few inputs on thesecond input device can facilitate integrating the control functionalityof the second input device into the handle of the catheter. Further inaddition, or further in the alternative, the simple interface of thesecond input device can advantageously reduce the physician's need tolook at the second input device, which can be useful for maintaining thephysician's focus on the graphical user interface during a medicalprocedure.

Other aspects, features, and advantages will be apparent from thedescription and drawings, and from the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic representation of a system during a medicaltreatment, the system including a catheter, a catheter interface unit, afirst input device, and a second input device.

FIG. 2 is a top view of the catheter of the system of FIG. 1 .

FIG. 3 is a schematic representation of a tip portion of the catheter ofFIG. 2 , with the tip portion depicted as inserted into a heart cavityof the patient of FIG. 1 .

FIG. 4 is a schematic representation of a graphical user interface ofthe system of FIG. 1 .

FIG. 5 is a schematic representation of a state machine corresponding tomenu options on a second portion of the graphical user interface of FIG.4 .

FIG. 6 is a flowchart of an exemplary method of controlling a graphicalrepresentation on the graphical user interface of the system of FIG. 1 .

FIG. 7 is a flowchart of an exemplary method of controlling a graphicalrepresentation on the graphical user interface of the system of FIG. 1 .

FIG. 8 is a schematic representation of a system during a medicaltreatment, the system including a catheter, a catheter interface unit, afirst input device, and a second input device separate from thecatheter.

FIG. 9 is a schematic representation of a system during a medicaltreatment, the system including a catheter, a catheter interface unit, afirst input device, and a second input device.

FIG. 10 is an isometric view of the catheter and the second input deviceof FIG. 9 .

FIG. 11 is a side view of the second input device and a portion of thecatheter of FIG. 9 .

FIG. 12 is an isometric view of the second input device of FIG. 9 .

Like reference symbols in the various drawings indicate like elements.

DETAILED DESCRIPTION

The present disclosure is generally directed to devices, systems, andmethods of facilitating a physician's interactions with a graphical userinterface associated with a medical procedure being performed by thephysician. For example, the devices, systems, and methods of the presentdisclosure can facilitate the physician's ability to modify arepresentation of a three-dimensional model on the graphical userinterface autonomously (e.g., without assistance from a second person),without interfering with the physician's ability to control the catheterduring the medical procedure. By way of non-limiting example and for thesake of clarity of explanation, the devices, systems, and methods of thepresent disclosure are described with respect to the use of a catheterin a heart cavity of a patient during a medical procedure (e.g., cardiacablation).

However, it should be appreciated that, unless otherwise specified ormade clear from the context, the systems and methods of the presentdisclosure can be used for any of various different medical proceduresin which it is desirable for a physician to interact with a graphicaluser interface autonomously while simultaneously maintaining controlover the medical device used as part of the medical procedure.

As used herein, the term “physician” should be considered to include anytype of medical personnel who may be directly interacting with acatheter as part of a medical procedure and is used interchangeablyherein with the term “user.” The term “treatment” should be consideredto include any manner and type of medical procedure involving the use ofa catheter and, therefore, should be considered to include diagnosis,treatment, and combinations thereof, unless otherwise specified or madeclear from the context.

In the following description, it is understood that terms such as“first,” “second,” “top,” “bottom,” “up,” “down,” “right,” “left,” andthe like, are words of convenience and are not to be construed aslimiting terms.

FIG. 1 is a schematic representation of a system 100 during a cardiactreatment (e.g., an ablation treatment) performed on a patient 102. Thesystem 100 can include a catheter interface unit 104 in communication(e.g., wired or wireless communication) with a catheter 106, a firstinput device 108, and a second input device 110. For example, thecatheter interface unit 104 can be in communication with the catheter106 via an extension cable 111 and, additionally or alternatively, inwireless communication with one or more of the first input device 108and the second input device 110. The catheter interface unit 104 caninclude a processing unit 112, a non-transitory, computer readablestorage medium 114, and a graphical user interface 116. The processingunit 112 can be a controller including one or more processors, and thestorage medium 114 can have stored thereon computer executableinstructions for causing the one or more processors of the processingunit 112 to carry out one or more of the various methods describedherein. In certain implementations, the catheter interface unit 104 caninclude additional features, including, without limitation, one or moreof the following: current generation; magnetic field generation;magnetic field sensing, and the like.

The first input device 108 can be a computer (e.g., a desktop computer,a laptop computer, or both), or other, similar input device. The firstinput device 108 can be operated, for example, by a technician outsideof a sterile field, while the second input device 110 can include asimple interface suitable for operation by the physician within thesterile field. As described in greater detail below, the catheterinterface unit 104 can receive one or more input commands from the firstinput device 108 and from the second input device 110, in response torespective input options on the graphical user interface 116. Based onthe received one or more input commands, the catheter interface unit 104can modify a three-dimensional model of a heart cavity of the patient102 displayed on the graphical user interface 116.

The input options available to be controlled by the second input device110 on the graphical user interface 116 can be state-dependent, as alsodescribed in greater detail below, such that the second input device 110can be used to interact extensively with the graphical user interface116 through the use of only a few input sources (e.g., buttons) on thesecond input device 110. That is, the input options corresponding to theinput sources on the second input device 110 at any given time during amedical procedure can be displayed on the graphical user interface 116.Advantageously, as also described in greater detail below, these inputoptions can change according to a state of a state machine, which itselfcan change according to context (e.g., based on one or more previousactions, a current state, or a combination of both) and/or inputs. Thus,for example, the meaning of pressing a particular input source (e.g.,pressing an “up” button) can change based on the state of the statemachine, and the meaning of the particular input source at any giventime can be displayed to the physician via the graphical user interface116. Accordingly, as compared to systems in which controller actions aredisplayed on a handle of a device or on the controller itself and/or areotherwise fixed, the dynamic interaction between the second input device110 and the graphical user interface 116 can facilitate the use of thestate machine which, in turn, can facilitate achieving a given level ofcontrol over the graphical user interface 116 using fewer input sourceson the second input device 110. With fewer input sources, the secondinput device 110 can be made into a form factor suitable for integrationinto a medical device such as the catheter 106, as described in furtherdetail below.

It should be appreciated that, in implementations in which the secondinput device 110 includes only a few input sources, a physician can usethe second input device 110 to interact with the graphical userinterface 116 while maintaining control over the catheter 106 during themedical procedure and, thus, while remaining in a sterile field. In suchimplementations, it should be further appreciated that the limitednumber of input sources on the second input device 110 can make iteasier for the physician to use the second input device 110 to interactwith the graphical user interface 116 with less of a need to switchfocus between the graphical user interface 116 and the second inputdevice 110. Thus, for example, because the second input device 110includes only a few input sources, the physician has less of a need tolook at the second input device 110 during operation of the second inputdevice 110. For at least this reason, the simplified inputs of thesecond input device 110 can facilitate continuous manipulation of thecatheter 106 by the physician, particularly in instances in which thephysician must look at the graphical user interface 116 to manipulatethe catheter 106 during a medical procedure.

Referring now to FIGS. 1 and 2 , the catheter 106 can include a cathetershaft 118, a handle portion 120, and a tip portion 122. The cathetershaft 118 includes a proximal end region 124 and a distal end region126. The handle portion 120 is coupled to the proximal end region 124and the tip portion 122 is coupled to the distal end region 126. Thesecond input device 110 can be coupled to the handle portion 120 and cancommunicate with the graphical user interface 116 such that the secondinput device 110 should be understood to be a graphical user interface(GUI) controller according to all aspects of the present disclosure. Anarticulation controller 128 can also, or instead, be supported on thehandle portion 120. Thus, as described in greater detail below, thesecond input device 110 can be operated to communicate with the catheterinterface unit 104 (e.g., with the processing unit 112) such thatcommands received by the catheter interface unit 104 from the secondinput device 110 can form the basis of one or more changes to athree-dimensional model of a heart cavity of the patient 102 displayedon the graphical user interface 116 while the articulation controller128 can be operated to move the tip portion 122 of the catheter 106 inthe heart cavity.

The second input device 110 can be in remote communication with thegraphical user interface 116 and, for example, can include a transmitter(e.g., a wired transmitter, a wireless transmitter, or both) for suchremote communication. In implementations in which the second inputdevice 110 includes a wired transmitter, communication between thesecond input device 110 and the catheter interface unit 104 can be viawires 111 extending from the catheter 106 to the catheter interface unit104. In addition, or in the alternative, in implementations in which thesecond input device 110 includes a wireless transmitter, communicationbetween the second input device 110 and the catheter interface unit 104can include communication via any of various different known wirelesscommunication protocols. An example of such a wireless communicationprotocol is Bluetooth^(●), a wireless standard available from BluetoothSIG, Inc. While a standardized communication protocol, such asBluetooth^(●), may be useful for pairing off-the-shelf hardwarecomponents, it should be appreciated that a customized communicationprotocol can be useful for avoiding interference with the communicationbetween the second input device 110 and the catheter interface unit 104.

The form factor of the second input device 110 can be based on one ormore of the size of the handle portion 120 and the orientation of thesecond input device 110 relative to the articulation controller 128.Thus, a small form factor of the second input device 110 can bedesirable for sizing the handle portion 120, for example, for ease ofoperation by the physician (e.g., one-handed operation). To achieve asmall form factor, the second input device 110 can include a smallnumber of input options (e.g., less than ten) arranged relative to oneanother in a space-efficient and, or instead, intuitive manner.Additionally, or alternatively, it can be desirable to include a smallnumber of input options on the second input device 110 to provide asimple interface that can be operated by the physician with little to noneed for the physician's attention to move back and forth from thegraphical user interface 116 to the second input device 110. That is,the simple interface provided by the second input device 110 can, incertain instances, be used by the physician without requiring thephysician to look at the second input device 110, making it easier forthe physician's attention to remain on the graphical user interface 116during a medical procedure. It should be appreciated, however, thatproviding a physician with access to a diverse set of actions on thegraphical user interface 116 can additionally, or alternatively, bedesirable. To manage these competing design considerations, as describedin greater detail below, the simple interface of the second input device110 can cooperate with the graphical user interface 116 to provide thephysician with state-dependent functionality, on the graphical userinterface 116, which can be both useful for a given state of the medicalprocedure and easily navigated using the small number of inputs on thesecond input device 110.

The second input device 110 can include inputs 130 a, 130 b, 130 c, 130d, 130 e spatially arranged relative to one another to facilitateintuitive navigation, using the second input device 110, through one ormore menus on the graphical user interface 116. The inputs 130 a, 130 b,130 c, 130 d, can be discrete navigation inputs separate from oneanother. Thus, by way of non-limiting example, the navigation inputs 130a, 130 b, 130 c, 130 d can be arranged in a right (130 a), left (130 b),up (130 c), and down (130 d) configuration relative to one another suchthat pressing the right navigation input 130 a corresponds to navigationto the right in a menu displayed on the graphical user interface 116,pressing the left navigation input 130 b corresponds to navigation tothe left in a menu displayed on the graphical user interface 116, etc.Additionally, or alternatively, the input 130 e can be an “enter” inputand can be arranged, for example, substantially in the middle of thenavigation inputs 130 a, 130 b, 130 c, 130 d. Further in addition, orfurther in the alternative, the press time and/or number of presses(e.g., single click versus double click) associated with pressing one ormore of the inputs 130 a, 130 b, 130 c, 130 d, and 130 e can be used toachieve further functionality of the second input device 110 using alimited number of inputs. For example, a long press time of one or moreof the inputs 130 a, 130 b, 130 c, 130 d, and 130 e can change a highlevel state of the state machine controlled by the second input device110 while a short press time of one or more of the inputs 130 a, 130 b,130 c, 130 d, and 130 e can scroll through a lower level state of thestate machine controlled by the second input device 110.

The navigation inputs 130 a, 130 b, 130 c, 130 d can be, in certaininstances, buttons that are pressed to provide input to the second inputdevice 110. Additionally, or alternatively, the second input device 110can include a capacitive touch portion such that, for example, a slidingmotion (e.g., of a finger) across the capacitive touch portion can be anavigation input transmitted by the second input device 110 to thegraphical user interface 116. The capacitive touch portion can bearranged, in certain instances, as a circle such that a sliding motiondetected around the circle is interpreted as a navigation inputcorresponding to scrolling (e.g., through a menu on the graphical userinterface 116). Additionally, or alternatively, the capacitive touchportion can include any one or more of the inputs 130 a, 130 b, 130 c,130 d, 130 e. More generally, the inputs 130 a, 130 b, 130 c, 130 d, 130e can be any of various different types, alone or in combination withone another and can, in addition or optionally, be of any number usefulfor navigating through one or more menus displayed on the graphical userinterface 116.

In some implementations, a combination of the number, size, and shape ofthe inputs 130 a, 130 b, 130 c, 130 d, 130 e is such that the user candistinguish the buttons by feel. For example, given that the inputs 130a, 130 b, 130 c, 130 d, 130 e are in a constant position relative to oneanother and in a relatively constant position with respect to an axisdefined by the catheter 106 (e.g., with respect to an axis defined bythe catheter shaft 118). Accordingly, the inputs 130 c and 130 d aretypically to the physician's right and left as the physician grips thehandle 120. The inputs 130 a and 130 b can be in similarly predictablepositions with respect to the physician's hand, given that the inputs130 a and 130 b are in a fixed positon relative to the inputs 130 c and130 d.

In certain implementations, the second input device 110 can include anorientation feature 132 extending from a surface of the second inputdevice 110. For example, the orientation feature 132 can extend from asurface of the up navigation input 130 c. The orientation feature 132can provide tactile feedback to the physician regarding the position ofthe physician's hand with respect to the second input device 110. Thus,in use, the physician can use tactile feedback from the orientationfeature 132 to discern, without needing to look at the second inputdevice 110, the position of the physician's hand with respect to theinputs 130 a, 130 b, 130 c, 130 d, 130 e. This can be useful, forexample, for facilitating switching back and forth, by the physician,between the operation of the articulation controller 128 and the secondinput device 110.

In general, the second input device 110 can be disposed relative to thearticulation controller 128 along the handle portion 120. Moregenerally, according to any one or more of the various differentarrangements of the second input device 110 relative to the articulationcontroller 128 described herein, the physician can operate the secondinput device 110 to modify the graphical user interface 116 to achieve adesired view of the tip portion 122 of the catheter 106 on the graphicaluser interface 116 and, based on this desired view on the graphical userinterface 116, can operate the articulation controller 128 to move thetip portion 122 of the catheter 106 to a desired location (e.g., intocontact with tissue). In certain instances, the physician can control(e.g., maintain in place) the distal end region 126 of the cathetershaft 118 while simultaneously manipulating the second input device 110according to any one or more of the methods described herein.Accordingly, it should be understood that such relative positioning ofthe articulation controller 128 relative to the second input device 110along the handle portion 120 can include any of various differentconfigurations that advantageously facilitate coordinated operation ofthe articulation controller 128 and the second input device 110.

In certain implementations, the second input device 110 can be disposedrelative to the articulation controller 128 along the handle portion 120such that the physician can manipulate the second input device 110 andthe articulation controller 128 through one-handed operation. As usedherein, one-handed operation should be understood to includemanipulating the second input device 110 substantially simultaneouslywith manipulation of the articulation controller 128 using anycombination of fingers of a single hand of the physician while thesingle hand of the physician maintains the same grip of the handleportion 120), leaving the physician with a free hand during the medicalprocedure. Such one-handed operation of the second input device 110 andthe articulation controller 128 can be useful, for example, for allowingthe physician to grip the catheter shaft 118 with a free hand tomaintain the distal end region 126 in place in the heart cavity of thepatient 102.

As an example, the second input device 110 can be coupled to the handleportion 120 at a position distal to the articulation controller 128 tofacilitate operation of the articulation controller 128 with a thumb andmanipulation of the second input device 110 with an index finger of thesame hand while that hand maintains a natural grip of the handle portion120.

Additionally, or alternatively, the second input device 110 can becoupled to the handle portion 120 along an axial position at which thearticulation controller 128 is positioned on the handle portion 120. Thearticulation controller 128 can be movable, in certain instances, alonga plane substantially perpendicular to a direction of movement of one ormore of the inputs 130 a, 130 b, 130 c, 130 d, 130 e. Such anorientation of the articulation controller 128 relative to the inputs130 a, 130 b, 130 c, 130 d, 130 e can be useful directing forcesassociated with manipulation of the articulation controller 128 in adirection different from a direction of forces associated with the oneor more inputs 130 a, 130 b, 130 c, 130 d, 130 e, which can facilitatesubstantially simultaneous but substantially independent operation ofthe articulation controller 128 and the one or more inputs 130 a, 130 b,130 c, 130 d, 130 e.

Further or instead, one or more inputs 130 a, 130 b, 130 c, 130 d, 130 ecan be positioned to facilitate other types of one-handed operation. Forexample, the one or more inputs 130 a, 130 b, 130 c, 130 d, 130 e can bepositioned relative to the catheter shaft 118 such that the one or moreinputs 130 a, 130 b, 130 c, 130 d, 130 e are manipulatable by a hand ofthe user while the same hand of the user applies an axial force to thecatheter shaft 118 (e.g., through gripping the catheter shaft 118between a thumb and another finger of a single hand). As an additionalor alternative example, the one or more inputs 130 a, 130 b, 130 c, 130d, 130 e can be positioned relative to the catheter shaft 118 such thatone or more inputs 130 a, 130 b, 130 c, 130 d, 130 e are manipulatableby a hand of the user while the same hand of the user applies torque tothe handle portion 120.

In some implementations, the second input device 110 can be rotatablycoupled to the handle portion 120 such that the second input device 110is rotatable about a circumference of the catheter shaft 118. In suchimplementations, operation of the second input device 110 and thearticulation controller 128 can include rotating the second input device110 relative to the catheter shaft 118 and, thus, relative to thearticulation controller 128 to bring the second input device 110 intoproximity to the articulation controller 128 and/or to the physician'shand during a procedure. Accordingly, it should be appreciated thatrotation of the second input device 110 relative to the catheter shaft118 can, in certain instances, facilitate one-handed operation of thesecond input device 110 and the articulation controller 128.

The second input device 110 can be, for example, rotatable (e.g.,between zero degrees and about 180 degrees) about the circumference ofthe catheter shaft 118. As a more specific example, the second inputdevice 110 can rotate freely about the circumference of the cathetershaft 118 such that the second input device 110 can be moved unimpededabout the circumference of the catheter shaft 118 through multiplerotations in any given direction. Such free rotation of the second inputdevice 110 can facilitate moving the second input device 110 quicklyinto a desired position. For example, the physician can spin the secondinput device 110 into a desired position. Additionally, oralternatively, with free rotation about the catheter shaft 118, thephysician can move the second input device 110 into place using anyfinger that might not otherwise be engaged during a medical procedure.

In some implementations, the second input device 110 can be releasablycoupled to the handle portion 120. For example, a releasable couplingbetween the second input device 110 and the handle portion 120 caninclude a pin-and-socket configuration in which electrical communicationand mechanical coupling between the second input device 110 and thehandle portion 120 are established at substantially the same time aspins extending from the second input device 110 are inserted intocorresponding sockets defined by the handle portion 120.

The second input device 110 can be sterilizable. For example, the secondinput device 110 can be formed of components compatible withsterilization according to one or more of the following sterilizationtechniques: ethylene oxide sterilization, autoclave sterilization, gammaradiation, gas-plasma sterilization. In implementations in which thesecond input device 110 is releasably coupled to the handle portion 120,the second input device 110 can be sterilizable separately from thehandle portion 120. Further, or instead, the second input device 110 canbe reusable such that the second input device 110 can be sterilizedbetween uses and secured to a new handle portion 120 for each use.

The articulation controller 128 can be in mechanical communication withthe catheter shaft 118. In operation, the articulation controller 128can modify the position of the distal end region 126 of the cathetershaft 118 and, thus, modify the position of the tip portion 122 of thecatheter 106. As an example, one or more pull wires (not shown) cancouple the articulation controller 128 to the catheter shaft 118 as isknown in the art.

Operation of the articulation controller 128 can move one or more of thepull wires in a proximal direction to create a deflection force at thedistal end region 126 of the catheter shaft 118. For example, thearticulation controller 128 can include one or more levers rotatableabout an axis substantially perpendicular to an axis defined by thehandle portion 120, with the rotation of the articulation controller 128moving one or more of the pull wires to deflect the distal end region126 of the catheter shaft 118. Additionally, or alternatively, thearticular controller 128 can include a plunger (e.g., proximal or distalto the handle portion 120) movable along an axis substantially parallelto an axis defined by the handle portion 120, with proximal and distalmovement of the articulation controller 128 moving one or more pullwires to move the distal end region 126 of the catheter shaft between adeflected position and a straight position. Because the tip portion 122is coupled to the distal end region 126 of the catheter shaft 118, thedeflection force at the distal end region 126 of the catheter shaft 118can deflect the tip portion 122. While the articulation controller 128has been described as being in mechanical communication with thecatheter shaft 118 via one or more pull wires, it should be appreciatedthe articulation controller 128 can additionally, or alternatively, bein mechanical communication with the catheter shaft 118 through any oneor more methods known in the art (e.g., through torque transmitted via arotating member).

The catheter 106 can further, or instead, include a magnetic positionsensor 133 along the distal end region 126 of the catheter shaft 118.The magnetic position sensor 133 can be any of various magnetic positionsensors well known in the art and can be positioned at any point alongthe distal end region 126. The magnetic position sensor 133 can, forexample, include one or more coils that detect signals emanating frommagnetic field generators. One or more coils for determining positionwith five or six degrees of freedom can be used.

The magnetic field detected by the magnetic position sensor 133 can beused to determine the position of the distal end region 126 of thecatheter shaft 118 according to one or more methods commonly known inthe art such as, for example, methods based on using a sensor, such asthe magnetic position sensor 133, to sense magnetic fields and using alook-up table to determine location of the magnetic position sensor 133.Because the tip portion 122 is coupled to the distal end region 126 ofthe catheter shaft 118 in a known, fixed relationship to the magneticposition sensor 133, the magnetic position sensor 133 can provide thelocation of the tip portion 122. While the location of the tip portion122 is described as being determined based on magnetic position sensing,other position sensing methods can additionally or alternatively beused. For example, the location of the tip portion 122 can beadditionally, or alternatively, based on impedance, ultrasound, and/orimaging (e.g., real time MRI or fluoroscopy).

The tip portion 122 can be one or more of a diagnostic tip and atreatment tip for directing energy (e.g., RF energy, ultrasound energy,chemical energy) toward tissue of the heart cavity. For example, the tipportion 122 can include at least one electrode mechanically coupled(e.g., directly coupled or indirectly coupled) to the distal end region126 of the catheter shaft 118. The at least one electrode can be,additionally or alternatively, disposed along an expandable elementcoupled to the distal end region 126 of the catheter shaft 118.

Referring now to FIG. 3 , in use, the tip portion 122 can be insertedinto a heart cavity 134 of the patient 102 (FIG. 2 ) as part of themedical procedure. In certain implementations, the tip portion 122 caninteract with a surface 135 of the heart cavity 134 as part of a medicalprocedure. For example, the tip portion 122 can deliver energy to thesurface 135 for the purpose of treatment, diagnosis, or both. The energydelivered through the tip portion 122 can include any manner and form ofenergy known in the art and, therefore, can include RF energy.

The location of the tip portion 122 relative to the surface 135 of theheart cavity 134 can be known (e.g., based on a signal received from themagnetic position sensor 133 of FIG. 2 ). Further, or in thealternative, the shape of the surface 135 of the heart cavity 134 can beknown based on any of various different methods, including methods basedon known locations visited by the tip portion 122 within the heartcavity 134. Accordingly, as described in greater detail below, thegraphical user interface 116 can represent the location of the tipportion 122 relative to the surface 135 on the graphical user interface116. Thus, in medical procedures in which direct visualization of thetip portion 122 in the heart cavity 134 is not possible, or is at leastimpractical, a physician can use the graphical user interface 116 as atool for visualization of the tip portion 122 and/or the heart cavity134 during a medical procedure.

Referring now to FIGS. 1-4 , the graphical user interface 116 caninclude any of various different types of two-dimensional and/orthree-dimensional displays known in the art. Thus, for example, thegraphical user interface 116 can include a computer monitor or anothersimilar type of two-dimensional display. Additionally, or alternatively,the graphical user interface 116 can include an augmented realityenvironment, a virtual reality environment, or combinations thereof.

The graphical user interface 116 can include a first portion 136 and asecond portion 138 spatially delineated from the first portion 136. Ingeneral, the spatial delineation between the first portion 136 and thesecond portion 138 can facilitate accommodating two different use caseson the graphical user interface 116 at the same time. For example, thesecond portion 138 can work in cooperation with the limited inputs ofthe second input device 110 to provide the physician with a robustinterface while the first portion 136 can cooperate with more expansiveinput options available through the first input device 108 (e.g., inputoptions compatible with a full keyboard, a mouse, or combinationsthereof). In general, these use cases are not interchangeable with oneanother as efficient input solutions. That is, it would be inefficientto use the second input device 110, with limited input options, tooperate the first portion 136 of the graphical user interface 116, andthe opposite case of operating the first input device 108, with multipleinput options, to navigate through a state machine represented on thesecond portion 138 of the graphical user interface 116 is also aninefficient input solution. Accordingly, the spatial delineation betweenthe first input portion 136 and the second input portion 138 can beuseful for providing different users with user interface elements thatare appropriate for a given use case associated with the respectiveuser.

In certain implementations, spatial delineation of the first portion 136from the second portion 138 can be useful for facilitating switchingfocus between the first portion 136 and the second portion 138 by aphysician during a medical procedure. For example, because the secondportion 138 is in a readily identifiable location (e.g., centered on thegraphical user interface 116) relative to the first portion 136 on thegraphical user interface 116, the physician can easily switch focus backand forth between the first portion 136 and the second portion 138 withlittle time and effort expended to locate or relocate thephysician-specific interface on the second portion 138 of the graphicaluser interface 116. Further, or in the alternative, such spatialdelineation of the first portion 136 from the second portion 138 canfacilitate concurrent, or substantially concurrent, use of the graphicaluser interface 116 by two different users, as described in greaterdetail below.

The first portion 136 of the graphical user interface 116 can include afirst set of input options 140 and, further or instead, a graphicalrepresentation 142 of the heart cavity 134. As used herein, thegraphical representation 142 of the heart cavity 134 can include partialdepictions of the heart cavity 134, such as those that may be generatedin implementations in which the graphical representation 142 is builtbased on known locations of the catheter 106. The first set of inputoptions 140 can correspond to permissible modifications and/or displaysettings of the graphical representation 142. Such modifications and/ordisplay settings of the graphical representation 142 can correspond toone or more input commands based on the first set of input options 140and received in preparation for and/or during a medical procedure.

The graphical representation 142 can be based, for example, on the shapeof the surface 135 of the heart cavity 134 such that the graphicalrepresentation 142 can include at least one two-dimensional projectionof a three-dimensional model of the heart cavity 134. Additionally, oralternatively, the graphical representation 142 can include a depictionof a portion of the catheter 106 (e.g., the tip portion 122), which canbe useful for locating the portion of the catheter 106 relative to theheart cavity 134. As shown in FIG. 4 , the graphical representation 142can include, for example, more than one two-dimensional projection of athree-dimensional model of the heart cavity 134, with eachtwo-dimensional projection projected to a different image plane and,thus, corresponding to a different view of the three-dimensional modelof the heart cavity 134.

The second portion 138 of the graphical user interface 116 can include asecond set of input options 144. The second set of input options 144 canadvantageously be different from the first set of input options 140, asdescribed in greater detail below. In general, the second set of inputoptions 144 can correspond to permissible modifications and/or displaysettings associated with the graphical representation 142 in the firstportion 136 of the graphical user interface 116. Such modifications ofthe graphical representation 142 can correspond to one or more inputcommands based on the second set of input options 144 and received inpreparation for and/or during a medical procedure.

The first input device 108 can be in communication with the firstportion 136 of the graphical user interface 116 while the second inputdevice 110 can be in communication with the second portion 138 of thegraphical user interface 116. In general, a first user (e.g., atechnician outside of a sterile field) can use the first input device108 to interact with the first set of input options 140 on the graphicaluser interface 116, and a second user (e.g., a physician within asterile field) can use the second input device 110 to interact with thesecond set of input options 144 on the graphical user interface 116while concurrently, or substantially concurrently, manipulating thecatheter 106. Because the second user can be constrained (e.g., byrequirements for maintaining the sterile field and/or the need tomanipulate the catheter 106), the second set of input options 144 canadvantageously be state-dependent to facilitate navigation of the secondset of input options 144 using only a limited number of inputs, such asthe inputs 130 a, 130 b, 130 c, 130 d, 130 e, of the second input device110.

As used herein, the term “state-dependent” is inclusive of a statemachine in which the second set of input options 144 can be in one of aset number of conditions, or states, based on one or more previousstates and on previous inputs, with state transitions in such a statemachine depending on the present state and the present inputs. Examplesof a state-machine associated with the second set of input options 144are described in greater detail below. In general, however, the secondset of input options 144 can be state-dependent such that, although agiven state of the second set of input options 144 may be a reduced setof options as compared to the first set of input options 140, thecombination of the states of the second set of input options 144 canoffer functionality equivalent or similar to the functionality availablethrough all or a subset of the first set of input options 140.

The second portion 138 of the graphical user interface 116 can include,for example, a banner section 146 and a menu section 148. Incombination, the banner section 146 and the menu section 148 can presentthe second set of input options 144 corresponding to the current stateof a plurality of states of the state machine. Also, or instead, thecombination of the banner section 146 and the menu section 148 canprovide the physician with visual context for navigating to other statesof the state machine. Such visual context can facilitate, for example,efficient navigation to the various states of the state machine (e.g.,as necessitated during the medical procedure) using only a limitednumber of inputs, such as the inputs 130 a, 130 b, 130 c, 130 d, 130 eof the second input device 110.

FIG. 5 is a schematic representation of an example of a state machine150 implemented on the catheter interface unit 104 (FIG. 1 ). For thesake of clarity of representation, the states of the state machine 150are generally represented relative to one another in two-dimensions inFIG. 5 . Each arrow between states of the state machine 150 represents anavigation input command that will move the state machine 150 from onestate to another. Thus, in the example shown in FIG. 5 , right/leftnavigation commands received from the second input device 110 (FIG. 2 )move to the right or left, as the case may be, of a given state, andup/down navigation commands received from the second input device 110(FIG. 2 ) move up or down, as the case may be, relative to a givenstate. It should be appreciated, however, that additional or alternativerelationships between navigations inputs from the second input device110 (FIG. 2 ) can be used to navigate through the states of the statemachine 150. As an example, the press time (e.g., a long press time)associated with a navigation input command from the second input device110 can be used to skip to a particular state in the state machine 150.

Referring now to FIGS. 1-5 , as described in further detail below, thecurrent state of the state machine 150 can be represented on the secondportion 138 of the graphical user interface 116, and an adjacent stateor states of the state machine 150 can be represented on the secondportion 138 of the graphical user interface 116 (e.g., as a preview) tofacilitate navigation from one state to another.

The state machine 150 can have any of various different configurations,which can depend on, among other things, the configuration of the secondinput device 110, the configuration of the second set of input options144, the functionality to be provided to the physician, and/or theapplication to which the state machine is being applied. Accordingly,while specific implementations of the state machine 150 are describedherein by way of example, further or alternative implementations of thestate machine 150 are additionally or alternatively possible.

In general, the state machine 150 can include a top-level 152 and one ormore sublevels 153. The functionality described herein with respect tothe top-level 152 and the one or more sublevels 153 is by way of exampleand not limitation. Further, it should be appreciated that the statemachine 150 can include a layer above the top-level 152 through whichaccess to the state machine 150 is gained. For example, the statemachine 150 can include one or more layers above the top-level 152 toallow the physician to choose between an ablation mode and a mode inwhich the physician can work with the state machine 150 to modify thegraphical representation 142.

In the exemplary state machine 150, the top-level 152 includes a buildstate 154 a, a view state 156 a, and a tag state 158 a (sometimescollectively referred to herein as “top-level states” and sometimesindividually referred to herein as a “top-level state”). One or moresublevel state can be below each top-level state. For the sake ofclarity, the hierarchy of states of the state machine 150 is representedin FIG. 5 such that each top-level state has an element number endingwith “a,” each sublevel state below the respective top-level state isrepresented with the same element number ending with “b” (in the case ofa first sublevel state), and the input options corresponding to a givensublevel state are represented with the same element number ending with“c”.

Navigation through the states of the state machine 150 can berepresented in the second portion 138 of the graphical user interface116 (e.g., as a change in the state highlighted in the second portion138). In general, one or more of the inputs 130 a, 130 b, 130 c, 130 d,130 e of the second input device 110 can be used to send navigationcommands to the catheter interface unit 104 to navigate through thestates of the state machine 150 and one or more of the inputs 130 a, 130b, 130 c, 130 d, 130 e can be used to provide one or more input commandsto the catheter interface unit 104 to select a particular state of thestate machine 150. As navigation commands are sent to the catheterinterface unit 104, the representation of the states of the statemachine 150 on the second portion 138 of the graphical user interface116 can change accordingly. For example, the second portion 138 of thegraphical user interface 116 can highlight or otherwise accentuate thecurrent navigation position of the state machine 150. In certainimplementations, a received input command can select the currentnavigation position as the state of the state machine 150. Thus, as usedherein, a “navigation command” should be understood to include an inputsent from one or more of the inputs 130 a, 130 b, 130 c, 130 d, 130 e tothe catheter interface unit 104 to change a display of one or morestates on the second portion 138 of the graphical user interface 116,with the change of the display of the one or more states correspondingto navigation through the states of the state machine 150. Additionally,or alternatively, an “input command” should be understood to include aninput sent from one or more of the inputs 130 a, 130 b, 130 c, 130 d,130 e to the catheter interface unit to make a selection in the one ormore displayed states on the second portion 138 of the graphical userinterface 116.

Respective icons for the build state 154 a, the view state 156 a, andthe tag state 158 a can be displayed in the banner section 146 of thesecond portion 138 of the graphical user interface 116. These respectiveicons can advantageously provide a visual indication of the contents ofthe corresponding sublevel state displayed in the menu section 148 belowthe corresponding top-level state. For example, if an icon associatedwith the build state 154 a is highlighted in the banner section 146, thephysician can readily assess that the sublevel state shown in the menusection 148 corresponds to the build state 154 a.

In use, the inputs 130 a and 130 b (right/left) can be used to providenavigation commands to scroll across the sublevel states in the statemachine 150. It should be appreciated that scrolling across the sublevelstates in the state machine 150 can be advantageous for efficientnavigation at least because such scrolling reduces the need to use alsothe inputs 130 c and 130 d (up/down) to navigate to other sublevelstates of the state machine 150. For example, the physician can usesingle button operation (e.g., using only the input 130 a (right) oronly the input 130 b (left)) to scroll across the sublevel states.Scrolling across the sublevel states can be represented as a change inthe sublevel state shown or highlighted in the menu section 148.Optionally, a corresponding change in the display of the icons of thetop-level state can be shown in the banner section 146.

The inputs 130 c and 130 d (up/down) can be used to scroll through inputoptions within a given sublevel state of the state machine 150, with thescrolling within the sublevel state represented as a change in thesublevel state option shown or highlighted in the menu section 148. Forexample, the inputs 130 c and 130 d (up/down) can be used to scrollthrough first build input options 154 c′ in the first build sublevelstate 154 b′, second build input options 154 c″ in the second buildsublevel, first view input options 156 c′ in the first view sublevelstate, second view input options 156 c″ in the second view sublevelstate 156 b″, and tag input options 158 c in the tag sublevel state 158b.

As an example of navigation of the state machine 150, the physician canuse the inputs 130 a and 130 b (right/left) to scroll from the tagsublevel state 158 b to the view sublevel state 156 b″ to see optionsfor adjusting the graphical representation 142 on the first portion 136of the graphical user interface 116. This may be desirable, for example,for better visualization of the graphical representation 142 and, thus,for more accurate placement of tags on the graphical representation 142.As the physician scrolls from the tag sublevel state 158 b to the viewsublevel state 156 b″, the highlighted icon in the banner section 146can change accordingly to provide the physician with a visual indicationof the top-level state corresponding to the second set of input options144. The physician can select the desired sublevel state, which is theview sub level state 156 b″ in this example, by providing an inputcommand, such as an enter command via input 130 e. With the desiredsublevel state selected, the physician can use the inputs 130 c and 130d (up/down) to scroll through input options associated with the selectedsublevel state. It should be appreciated that other transitions betweenstates of the state-machine 150 are additionally, or alternatively,possible and can similarly facilitate execution of the medical procedureby the physician.

The build state 154 a can have a first build sublevel state 154 b′ and asecond build sublevel state 154 b″. The state machine 150 can be in oneor the other of the first build sublevel state 154 b′ and the secondbuild sublevel state 154 b″, depending on whether a build procedure isin progress. As used herein, the build procedure can include formationof a three-dimensional model of the heart cavity 134 used to form thegraphical representation 142 displayed on the graphical user interface116. For example, the build procedure can be based on received locationsof the tip portion 122 of the catheter 106 in the heart cavity 134.

The first build sublevel state 154 b′ can correspond to the buildprocedure being stopped. Accordingly, the first build sublevel state 154b′ can include an input for starting the build procedure, which can bedisplayed in the menu section 148 of the second portion 138 of thegraphical user interface 116. When the physician selects the input tostart the build procedure, the current state of the state machine 150can switch to the second build sublevel state 154 b″.

The second build sublevel state 154 b″ can correspond to the buildprocedure being in progress. Accordingly, the second build sublevelstate 154 b″ can include an input for stopping the build procedure,which can be displayed in the menu section 148 of the second portion 138of the graphical user interface 116. When the physician selects theinput to stop the build procedure, the current state of the statemachine 150 can switch to the first build level state 154 b′. Thus, thestate machine 150 moves between sublevel states (the first buildsublevel state 154 b′ and the second build sublevel state 154 b″, inthis example) to present the physician with input options that representthe next logical step or steps in the medical procedure, given thecurrent state of the state machine 150.

The view state 156 a can correspond to control of the graphicalrepresentation 142 on the first portion 136 of the graphical userinterface 116. For the sake of clarity of explanation, the state machine150 is described with respect to the view state 156 a controlling asingle view of the graphical representation 142. It should beappreciated, however, that the view state 156 a can include multiplestates, each corresponding to control of a different view of thegraphical representation 142 on the first portion 136 of the graphicaluser interface 116. For example, in instances in which a first view ofthe graphical representation 142 is displayed on the left side of thegraphical user interface 116 and a second view of the graphicalrepresentation 142 is displayed on the right side of the graphical userinterface 116, the view state 156 a can include states corresponding tothe respective views on the left side and right side of the graphicaluser interface 116.

The view state 156 a can include a first view sublevel state 156 b′ anda second view sublevel state 156 b″. While the view state 156 a isdescribed as having two sublevels, it should be appreciated that theview state 156 a can have any of various different sublevels. Ingeneral, the sublevels associated with the view state 156 a can dependon the amount of control to be provided to the physician with respect tothe graphical representation 142 on the first portion 136 of thegraphical user interface 116. Accordingly, the number of sublevelsassociated with the view state 156 a can depend on the particularimplementation. For example, in the case of implementations related tovisualization of a medical procedure performed on the heart cavity 134of the patient 102, the view state 156 a can include a sublevelassociated with rotation of the graphical representation 142 and asublevel associated with one or more fixed views of the graphicalrepresentation 142.

The state machine 150 can be in one or the other of the first viewsublevel state 156 b′ and the second view sublevel state 156 b″,depending on which of various, different view control features isselected. An example of a view control feature can be a fixed view modein which a plurality of fixed views (e.g., left-anterior oblique (LAO),right-anterior oblique (RAO), etc.) are displayed in the menu section148 such that the physician can scroll through the fixed views andselect a desired view. Additionally, or alternatively, a view controlfeature can be an adjustable view mode (e.g., in which the physician canadjust a view parameter such as tilt). Accordingly, in implementationsin which the first view sublevel state 156 b′ corresponds to a fixedview mode and the second view sublevel state 156 b″ corresponds to anadjustable view mode, the physician can switch between the fixed viewmode and the adjustable view mode as desired (e.g., by scrolling acrossthe sublevel states).

The tag state 158 a can have, for example, a single tag sublevel state158 b including a selection of identifiers corresponding to anatomicfeatures of the heart cavity. Thus, for example, when the top-levelstate of the state machine corresponds to the tag state 158 a, theidentifiers of the tag sublevel state 158 b can be displayed in the menusection 148 of the second portion 138 of the graphical user interface116. In use, the physician can navigate through the identifiersdisplayed in the menu section 148 using, for example, the inputs 130 a,130 b, 130 c, 130 d and can select an identifier using the input 130 e.As a result of this selection, an appropriate tag can appear on thegraphical representation 142 shown on the first portion 136 of thegraphical user interface 116. As an example, the appropriate tag canappear on the graphical representation 142 at a location based on thelocation of the catheter tip 122.

The tags available in the tag sublevel state 158 b can be a function ofthe global state of the state machine 150 and, thus, can themselves bestate dependent. For example, if the state machine 150 is in an“ablation” mode, the tags available in the tag sublevel state 158 b caninclude tags related to marking the location of one or more ablations onthe graphical representation 142. As an additional or alternativeexample, if the state machine 150 is in an “anatomy” mode, the tagsavailable in the tag sublevel state 158 b can correspond to markinganatomic features on the graphical representation 142. In cardiacimplementations, the tags available in the tag sublevel state 158 b canbe dependent on the chamber of the heart in which the catheter 106 isinserted. For example, information regarding the chamber can be receivedfrom the first input device 108 and/or the second input device 110, andthe tags in the tag sublevel state 158 b can be updated accordingly.

The computer executable instructions stored on the computer readablestorage medium 114 can cause the processing unit 112 to receive inputsfrom the first input device 108 and the second input device 110 tomodify the graphical representation 142 according to one or more of thefollowing exemplary methods. For example, the computer executableinstructions stored on the storage medium 114 and executable by theprocessing unit 112 can be an application built using VisualizationToolkit, an open-source 3D computer graphics toolkit, available atwww.vtk.org. Unless otherwise indicated or made clear from context, eachof the following exemplary methods can be implemented using the system100 and/or one or more components thereof.

FIG. 6 is a flowchart of an exemplary method 160 of controlling agraphical representation on a graphical user interface. The graphicalrepresentation and the graphical user interface can be, for example, anyof the various different graphical representations and graphical userinterfaces described herein. Accordingly, the exemplary method 160 cancontrol the display of the graphical representation 142 (FIG. 4 ) on thegraphical user interface 116 (FIGS. 1 and 4 ).

The exemplary method 160 can include receiving 162 a signal indicativeof location of a cardiac catheter in a cavity of a patient's heart,displaying 164 a graphical representation of the cavity of the patient'sheart, receiving 166 a a first input command based on a first set ofinput options, receiving 166 b a second input command based on a secondset of input options, and modifying 168 the graphical representationbased on the first input command and on the second input command. Thegraphical representation can be based on the received 162 signalindicative of location of the cardiac catheter and can be displayed on afirst portion of a graphical user interface, along with the first set ofinput options. The second set of input options can be displayed, forexample, on a second portion of the graphical user interface.

Receiving 162 the signal indicative of location of the cardiac catheterin the cavity of the patient's heart can include any of the variousdifferent methods described herein for determining a location of acardiac catheter in a heart cavity. For example, receiving 162 thesignal indicative of location of the cardiac catheter in the cavity ofthe patient's heart can include receiving a signal from a sensor such asthe magnetic position sensor 133 (FIG. 2 ). Further, it should beappreciated that the received 162 signal can be indicative of anypredetermined location of the cardiac catheter in the heart cavity.Accordingly, the received 162 signal can be indicative of a tip portion(e.g., tip portion 122) of the cardiac catheter.

In certain implementations, displaying 164 the graphical representationof the cavity of the patient's heart can include projecting a model(e.g., a three-dimensional model) of either or both of the cardiaccatheter and the cavity to an image plane corresponding to the graphicaluser interface. Further, or alternatively, displaying 164 the graphicalrepresentation can include displaying the cavity of the patient's heartin one or more views in the first portion of the graphical userinterface. Such multiple views can be useful, for example, forvisualizing movement of the cardiac catheter relative to one or moresurfaces of the cavity.

In certain implementations, displaying 164 the graphical representationcan include displaying only a graphical representation of the cardiaccatheter initially, while a graphical representation of the heart cavityis being built. As the graphical representation of the heart cavity isbuilt, displaying 164 the graphical representation can include updatingthe graphical representation to show the gradual generation of thegraphical representation of the heart cavity.

Displaying 164 the graphical representation can be based on the received166 a first input command and the received 166 b second input command.That is, in general, displaying 164 the graphical representation can bebased on inputs received from two different sources. Such multipleinputs can be useful, for example, for facilitating receiving inputdirectly from a physician while allowing a technician to provideadditional or alternative inputs for controlling the graphicalrepresentation.

Receiving 166 a the first input command from the first input device andreceiving 166 b the second input command from the second input devicecan occur concurrently. For example, receiving 166 a the first inputcommand can be along a first communication channel and receiving 166 bthe second input command can be along a second communication channel,different from the first communication channel. Each communicationchannel can be associated with a respective portion of the graphicaluser interface such that the first communication channel can beassociated with the first portion of the graphical user interface, uponwhich the first set of input options is displayed and, similarly, thesecond communication channel can be associated with the second portionof the graphical user interface, upon which the second set of inputoptions is displayed. It should be appreciated that during concurrentcommunication, one of the first communication channel or the secondcommunication channel can have a predetermined priority over the other.For example, the second communication channel can be given priority overthe first communication channel such that communication from the secondinput device associated with the physician is given priority overcommunication from the first input device.

One or both of receiving 166 a the first input command from the firstinput device and receiving 166 b the second input command from thesecond input device can include wireless or wired communicationaccording to any of the various different communication systems andmethods described herein. Further, one of the receiving 166 a the firstinput command from the first input device and receiving 166 b the secondinput command from the second input device can include wirelesscommunication while the other includes wired communication.

Receiving 166 a the first input command from the first input device caninclude receiving an input command from any of various different inputdevices known in the art, including, for example, one or more of akeyboard, a mouse, a touchscreen, etc. In general, the first inputcommand can be received 156 a from a technician, or other similarpersonnel, who is ordinarily not in the sterile field and, thus,ordinarily has full use of both hands to manipulate the first inputdevice. Accordingly, the second set of input options can be a subset ofthe first set of input options such that the technician may have accessto certain input options that are not available to the physician as thephysician operates the second input device during the medical procedure.That is, the technician can have access to input options associated withfunctions that are more efficiently carried out by the technician thanby the physician, who must also manipulate the catheter during themedical procedure.

The first set of input options from which the received 166 a first inputcommand is derived can be displayed along a portion of the graphicaluser interface that is ordinarily not an area of focus for thephysician. For example, the first set of input options can be on thefirst portion of the graphical user interface and, optionally, set offto one side of the graphical representation of the heart cavity. Itshould be appreciated that such orientation of the first set of inputoptions can be useful for efficient use of the space available on thegraphical user interface. For example, because the first set of inputoptions are not associated with the second input device operated by thephysician, placing the first set of input options in a non-centrallocation, or an otherwise deemphasized location, on the graphical userinterface can facilitate presentation of the most relevant informationto the physician during a medical procedure. That is, the second portionof the graphical user interface, upon which the second set of inputoptions is displayed, can be substantially centrally positioned on thegraphical user interface.

In general, receiving 166 b the second input command can includereceiving one or more commands from a remote device. As used herein, theterm “remote device” includes an input device that is spatiallyseparated from the first input device, from the graphical userinterface, and/or from a processing unit of a catheter interface unit.In general, such spatial separation can be delineated by a sterile fieldsuch that the term “remote device” is inclusive of a device thattransmits one or more input commands from within a sterile field to oneor more portions of the system outside of the sterile field.Accordingly, it should be appreciated that remote communication usingthe remote device can offer certain advantages for communicating with aprocessing unit or other portions of a catheter interface unit whilemaintaining the sterile field.

Receiving 166 b the second input command from the remote device caninclude receiving an input command from any of the various differentremote devices described herein. Thus, for example, receiving 166 b thesecond input command from the remote device can include receiving aninput command from a second input device disposed on a handle portion ofa catheter (e.g., the second input device 110 disposed on the handleportion 120 of the catheter 106 as described with respect to FIG. 2 ).Further, or in the alternative, receiving 166 b the second input commandfrom the remote device can include receiving an input command from asecond input device that is separate from a catheter, as described ingreater detail below.

Receiving 166 b the second input command can include receiving adiscrete selection command. The discrete selection command can include aclick, or other similar discrete input appropriate for the second inputdevice, corresponding to selection of one of the second set of inputoptions. For example, the discrete selection command can include aninput such as the input 130 e arranged as an “enter” input as describedwith respect to FIG. 2 . The instruction corresponding to the discreteselection command can vary depending on the state of a state machinerepresented in the second portion of the graphical user interface. Moregenerally, the instruction corresponding to the discrete selectioncommand can be based on the context ofa particular portion of themedical procedure and, thus, can change over the course of the medicalprocedure.

In certain implementations, the exemplary method 160 can further includereceiving 167 navigation commands for moving, within the second portionof the graphical user interface, between the options in the second setof options. As an example, the received 167 navigation commands caninclude discrete direction commands (e.g., left, right, up, and downcorresponding to input from one or more of inputs 130 a, 130 b, 130 c,130 d, and 130 e) in the second portion of the graphical user interface.Because the physician may have to manipulate the catheter whileproviding the navigation commands, such discrete direction commands canfacilitate navigating through the second portion of the graphical userinterface through a simplified user interface manipulated, for example,through one-handed operation by the physician.

The navigation commands can be received before and/or concurrently withreceiving 156 b the second input command. For example, one or more ofthe received 167 navigation commands and the received 156 b second inputcommand can be used to navigate through the various different states ofa state machine according to any one or more of the systems and methodsdescribed herein and, in particular, with respect to FIG. 5 .

At least one of the received 167 navigation commands can scroll throughthe second set of input options displayed as an infinite wheel. That is,repeated receipt 167 of a particular navigation command (e.g., a “left”command) can cycle through the second set of input options continuously.Such continuous cycling in response to repeated receipt 167 of aparticular navigation command can facilitate one-handed operation of thesecond input device to navigate the second set of input options. Forexample, if the physician inadvertently scrolls past a desired inputoption, the physician can continue to press the same navigation input(e.g., input 130 a, 130 b, 130 c, 130 d of FIG. 2 ) until the desiredinput appears again in the second portion of the graphical userinterface.

In some implementations, the exemplary method 160 can further includedetecting 169 receipt of an initial command. The initial command can bethe received 166 b second input command. By way of non-limiting example,the detected 169 receipt of the initial command can follow a period ofinactivity and/or a predetermined change in the second portion of thegraphical user interface. Additionally, or alternatively, the initialcommand can be one of the received 167 navigation commands.

In general, the first portion is viewable on the graphical userinterface at the same time that the second portion is viewable on thegraphical user interface, and it can be useful to delineate between thefirst portion and the second portion during the medical procedure. As anexample of such a delineation between the first portion and the secondportion, one or more display features of the second portion of thegraphical user interface can be changed based on the detected 169receipt of the initial command. Such a change in the second portion ofthe graphical user interface can advantageously provide the physicianwith feedback regarding proper operation of the second input device.That is, as the one or more display features of the second portion ofthe graphical user interface change, the change in the second portion ofthe graphical user interface can be perceived by the physician and,thus, serve as an indication that the commands from the second inputdevice are being reflected in the second portion of the graphical userinterface.

Changes to the one or more display features of the second portion of thegraphical user interface can include displaying additional input optionsof the second set of input options (e.g., displaying additional inputoptions related to a current state of the state machine such as thestate machine 150 described with respect to FIG. 5 ). For example,detecting 169 receipt of the initial command can result in expansion ofa menu to provide the physician with a visual representation ofadditional options. Additionally, or alternatively, detecting 169receipt of the initial command can result in displaying one or moremenus to provide the physician with a preview of menus that are adjacentto a current menu to facilitate navigation to an appropriate menu in thesecond portion of the graphical user interface.

In certain implementations, changing one or more display features of thesecond portion of the graphical user interface can include changing oneor more display features of the second portion of the graphical userinterface, relative to the first portion of the graphical userinterface, between a baseline configuration and a modifiedconfiguration. As an example, such a change can include changing thesize of the second portion of the graphical user interface relative tothe size of the first portion of the graphical user interface. Thus, insuch instances, detecting 169 receipt of the initial command can resultin the second portion of the graphical user interface increasing in sizerelative to the first portion of the graphical user interface. Thischange in size can make the second portion of the graphical userinterface easier to perceive by the physician and, thus, can facilitatenavigation through one or more menus displayed on the second portion ofthe graphical user interface.

In addition to, or as an alternative to, changing the size of the secondportion of the graphical user interface in response to detecting 169receipt of the initial command, changing the one or more displayfeatures of the second portion of the graphical user interface caninclude changing opacity of the second portion of the graphical userinterface relative to the opacity of the first portion of the graphicaluser interface. As an example, the baseline configuration of the secondportion of the graphical user interface can be relatively opaque priorto detecting 169 receipt of the initial command and can become lessopaque upon detecting 169 receipt of the initial command. Such a changein opacity of the second portion of the graphical user interface canmake the second portion of the graphical user interface more easilyperceivable by the physician.

Further in addition, or further in the alternative, changing one or moredisplay features of the second portion of the graphical user interfacerelative to the first portion of the graphical user interface caninclude changing the position of the second portion of the graphicaluser interface relative to the position of the first portion of thegraphical user interface. An example of such a change in position caninclude displaying the second portion of the graphical user interface asa pop-up window. For example, the pop-up window can appear in front ofthe first portion of the graphical user interface. More generally, achange in position of the second portion of the graphical user interfacerelative to the first portion of the graphical user interface canfacilitate prominently displaying the second portion of the userinterface for improved perceptibility by the physician during themedical procedure.

In some implementations, changing the one or more display features ofthe second portion of the graphical user interface relative to the firstportion of the graphical user interface can include changing the secondportion of the graphical user interface from the modified configurationto the baseline configuration if a time between receipt 169 of theinitial command and receipt of a subsequent input command exceeds apredetermined inactivity threshold period. For example, thepredetermined inactivity threshold period can be programmable (e.g., bythe physician according to the physician's preference). Such a period ofinactivity can coincide with the physician moving the catheter withinthe heart cavity. Accordingly, during this period, the second portion ofthe graphical user interface can be advantageously deemphasized in favorof a more prominent display of the first portion of the graphical userinterface, which includes the graphical representation of the heartcavity.

In certain implementations, changing the one or more display features ofthe second portion of the graphical user interface relative to the firstportion of the graphical user interface between the baselineconfiguration and the modified configuration can include changing thesecond portion of the graphical user interface from the modifiedconfiguration to the baseline configuration based on a received inputcommand of the second set of input commands. Further, or in thealternative, a received input command of the second set of inputcommands can toggle between the modified configuration and the baselineconfiguration. Toggling between the modified configuration and thebaseline configuration can, for example, provide the physician withcontrol over the display of the second portion of the graphical userinterface. Such control can be useful for deemphasizing the secondportion of the graphical user interface on command to facilitateobservation of the first portion of the graphical user interface by thephysician (e.g., during a particular portion of the medical procedure).

In general, modifying 168 the displayed graphical representation in thefirst portion of the graphical user interface can include any one ormore of various different changes to the displayed graphicalrepresentation that may improve visualization of the graphicalrepresentation by the physician. For example, modifying 168 thedisplayed graphical representation can include building a graphicalrepresentation of the heart cavity, altering a display view of thegraphical representation, and/or tagging one or more anatomic featureson the graphical representation. Because modifying 168 the displayedgraphical representation can be based on the received 166 a first inputcommand from the first input device and the received 166 b second inputcommand from the second input device, it should be appreciated thatrelatively simple modifications 168 of the displayed graphicalrepresentation can be implemented through the second input deviceoperated by the physician while more complex modifications 168 of thedisplayed graphical representation can be implemented through the firstinput device operated by the technician.

Modifying 168 the displayed graphical representation in the firstportion of the graphical user interface can include, for example,modifying a pose of the graphical representation including one or moreof a translation and an orientation. For example, the pose can includetwo rotation angles. The pose can correspond to one or morepredetermined poses of the graphical representation. Further, or in thealternative, the pose can be customizable according to one or moreinputs from one or both of the first input device and the second inputdevice. In certain implementations, modifying 168 the displayedgraphical representation can include adjusting an orientation of adisplayed view of the graphical representation of the heart cavity suchas, for example, by rotating the graphical representation of the heartcavity about an axis.

In certain implementations, modifying 168 the displayed graphicalrepresentation in the first portion of the graphical user interface caninclude adjusting the displayed graphical representation according tothe order in which the first input command the second input command arereceived. Such modification 168 of the displayed graphicalrepresentation can allow the physician to undo or otherwise modify aninput command provided by the technician through the first input device.More generally, the first input command and the second input command canoperate in concert to modify 168 the displayed graphical representation.

FIG. 7 is a flowchart of an exemplary method 170 of controlling agraphical representation on a graphical user interface. The graphicalrepresentation and the graphical user interface can be, for example, anyof the various different graphical representations and graphical userinterfaces described herein. Accordingly, the exemplary method 170 cancontrol the display of the graphical representation 142 (FIG. 4 ) on thegraphical user interface 116 (FIGS. 1 and 4 ).

The exemplary method 170 can include receiving 171 a signal indicativeof a location of a catheter tip in a cavity of a patient's heart,displaying 172, on a graphical user interface, a graphicalrepresentation of the location of the catheter tip in the cavity of thepatient's heart, receiving 174 a a first input command from a firstinput device, receiving 174 b navigation commands and a second inputcommand from a second input device, and modifying 176 the displayedgraphical representation based on the first input command and the secondinput command. The first input command can be responsive to a first setof input options displayed on the graphical user interface, and thesecond input command can be responsive to a second set of input optionsdisplayed on the graphical user interface.

Receiving 171 the signal indicative of the location of the catheter tipin the cavity of the patient's heart can include any one or more of thevarious different methods of receiving location information describedherein. For example, receiving 171 the signal indicative of location ofthe cardiac catheter in the cavity of the patient's heart can includereceiving a signal from a sensor such as the magnetic position sensor133 (FIG. 2 ). Further, it should be appreciated that the received 171signal can be indicative of any predetermined location of the cardiaccatheter in the heart cavity. Accordingly, the received 171 signal canbe indicative of a location of a tip portion (e.g., tip portion 122) ofthe cardiac catheter.

Displaying 172 the graphical representation of the cavity of thepatient's heart on the graphical user interface can include any of thevarious different methods of displaying the graphical representationdescribed herein. Accordingly, as an example, displaying 172 thegraphical representation can include displaying a two-dimensionalprojection of a three-dimensional model of the cavity of the patient'sheart. Additionally, or alternatively, displaying 172 the graphicalrepresentation of the cavity of the patient's heart on the graphicaluser interface can include displaying one or more views of the graphicalrepresentation.

The first input command can be received 174 a from the various differentdevices and systems described herein with respect to the first inputdevice and, additionally or alternatively, according to any one or moreof the various different methods described herein with respect tosending and receiving a first input command from the first input device.Thus, for example, the first input command can be received 174 a by acatheter interface unit via wired or wireless communication with akeyboard and/or mouse operated by a technician (e.g., outside of asterile field). The first input command can be received 174 a from amongthe first set of input options, which can be a full complement ofpossible input commands available for modifying the displayed 172graphical representation of the cavity of the patient's heart.Additionally, or alternatively, the first set of input options can bedisplayed on a dedicated portion of a graphical user interface, awayfrom the second set of input options, according to any of the variousdifferent methods described herein. Accordingly, the first set of inputoptions can be displayed on the first portion of the graphical userinterface, and the second set of input options on a second portion ofthe graphical user interface.

The navigation commands and/or the second input command can be received174 b from the various different devices and systems described hereinwith respect to the second input device and, additionally oralternatively, according to any one or more of the various differentmethods described herein with respect to sending and receivingnavigation commands and/or a second input command from the second inputdevice. For example, the navigation commands and the second inputcommand can be received 174 b by a catheter interface unit in wired orwireless communication with a second input device operated by aphysician. The second input device can be any of the various differentsecond input devices described herein.

In general, the second input device can include relatively few inputs ascompared to the first input device, with the functionality of the secondinput device being a function of the representation of a state machineon the graphical user interface. For example, the second set of inputoptions displayed on the graphical user interface can be based at leastin part on the current state of the state machine and, additionally oralternatively, can include available transitions of a state machine.Continuing with this example, the navigation input commands received 174b from the second input device can be used to navigate through thetransitions of the state machine and an input command received 174 bfrom the second input device can be used to select a particular state ofthe state machine. Accordingly, it should be appreciated that thechanging state of the state machine can impart additional functionalityto the inputs of the second input device. That is, the result producedby a given received 174 b input command can vary according to the stateof the state machine at the time the input command is received 174 b.

Receiving 174 b the navigation commands and the second input commandfrom the second input device can include receiving discrete commands.For example, the discrete commands can include commands for movingthrough the second set of input options. Examples of such discretedirectional commands can include commands corresponding to right, left,up, and down navigation through the second set of input commandsdisplayed in the second portion of the graphical user interface.

Also, or instead, receiving 174 b the navigation commands and the secondinput command from the second input device can include receiving one ormore analog commands. As an example, one or more inputs of the secondinput device can include a capacitive touch sensor that produces ananalog input command. This analog command can be used, in certaininstances, for navigating through the second set of input options. Forexample, in implementations in which the capacitive touch sensor isarranged as a scroll wheel, the scroll wheel can be used to scrollthrough the second set of input options.

The second set of input options can be arranged in an infinite wheelaccording to any of the arrangements described herein. In suchimplementations, receiving 174 b the navigation commands can includereceiving a scroll command (e.g., a discrete command, an analog command,or a combination thereof) for moving through the states of the infinitewheel. Thus, for example, a physician can press a single input on thesecond input device repeatedly, or by holding down the single input, tocontinually move through the infinite wheel until a desired inputcommand is highlighted and can be selected.

Modifying 176 the displayed graphical representation can include any oneor more of the various different modifications described herein.Accordingly, as an example, modifying 176 the displayed graphicalrepresentation can be based on the order in which the first inputcommand and the second input command are received. Thus, in thisexample, the second input command can override a modification made basedon the first input command and, in this way, can provide the physicianwith a mechanism for overriding a change made by the technician. Also,or instead, in instances in which the first input command and the secondinput command are received at the same time or substantially the sametime, the second input command can override the first input command toreduce the likelihood that the second input command (associated with thephysician) is inadvertently overwritten or otherwise undone by the firstinput command.

In some implementations, the exemplary method 170 can further includemodifying 177 one or more display features of the second set of inputoptions based on the received 174 b navigation command and/or secondinput command. Modifying 177 the one or more display features of thesecond set of input options can be based, for example, on detecting aninitial navigation or initial input command (e.g., after somepredetermined period of inactivity). Additionally, or alternatively,modifying 177 the one or more display features of the second set ofinput options can include changing the second set of input options fromthe modified configuration to the baseline configuration if a timebetween receipt of a first input command and receipt of a second inputcommand exceeds a predetermined inactivity threshold period.

In general, modifying 177 the one or more display features of the secondset of input options can include changing between a baselineconfiguration and a modified configuration of the display featuresaccording to any of the various different methods described herein.Thus, for example, the relative size of the displayed second set ofinput options to the size of the displayed first set of input optionscan be greater in the modified configuration than in the baselineconfiguration to facilitate reading the second set of input options bythe physician. In addition, or in the alternative, the opacity of thedisplayed second set of input options compared to the opacity of thefirst set of input options can be greater in the modified configurationthan in the baseline configuration to facilitate drawing the physician'sattention to the appropriate location on the graphical user interface.Additionally, or alternatively, the position of the second set of inputoptions relative to the first set of input options on the graphical userinterface can be different in the modified configuration than in thebaseline configuration, with the change in position, for example,advantageously drawing the physician's attention toward the second setof input options.

While certain implementations have been described, other implementationsare additionally or alternatively possible.

For example, while a second input device has been described as beingdisposed along a handle of a catheter, other implementations areadditionally or alternatively possible. As an example, referring now toFIG. 8 , a system 100′ can include a second input device 180 separatefrom a catheter 106′. For the sake of efficient and clear description,elements designated by prime (′) element numbers in FIG. 8 should beunderstood to be analogous to elements with unprimed element numbersdescribed herein, unless otherwise indicated or made clear from thecontext, and, thus, are not described separately from primed or unprimedcounterparts, except to highlight certain aspects. Thus, for example,element number 116′ in FIG. 8 should be understood to be a graphicaluser interface analogous to the graphical user interface 116 (FIGS. 1and 4 ), unless otherwise indicated or made clear from the context.

The second input device 180 can be, for example, in communication withthe catheter interface unit 104′ to transmit navigation commands and/orinput commands to a second portion of the graphical user interface 116′according to any of the various different methods described herein.Because the second input device 180 is not disposed along the catheter106′, the second input device 180 can be advantageously in wirelesscommunication with the catheter interface unit 104′ to reduce the numberof wires in the vicinity of the physician during the medical procedure.

In general, the second input device 180 can be manually operable by thephysician while the physician manipulates the catheter 106′. Forexample, the physician may pick up the second input device 180 asneeded, and then put the second input device 180 down if both hands areneeded for manipulation of the catheter 106′.

As another example, while the second input device has been described asbeing disposed along the handle of the catheter or as separate from thecatheter, other implementations are additionally or alternativelypossible. For example, referring now to FIGS. 9-12 , a system 100″ caninclude a second input device 210 securable to a catheter shaft 118″ ofa catheter 106″. For the sake of efficient and clear description,elements designated by double prime (″) element numbers in FIG. 9 shouldbe understood to be analogous to elements with unprimed and/or primedelement numbers described herein, unless otherwise indicated or madeclear from the context, and, thus, are not described separately fromprimed or unprimed counterparts, except to highlight certain aspects.Thus, for example, element number 106″ in FIG. 9 should be understood tobe a catheter analogous to the catheter 106 (FIGS. 1 and 4 ) and thecatheter 106′ (FIG. 8 ), and element number 118″ in FIG. 9 should beunderstood to be a catheter shaft analogous to the catheter shaft 118(FIGS. 1 and 4 ) and the catheter shaft 118′ (FIG. 8 ), unless otherwiseindicated or made clear from the context.

The second input device 210 can be in communication (e.g., wirelesscommunication) with the catheter interface unit 104″ to transmitnavigation commands and/or input commands to a second portion of thegraphical user interface 116″ according to any of the various differentmethods described herein. As described in greater detail below, securingthe second input device 210 to the catheter shaft 118″ of the catheter106″ can facilitate locating the second input device 210 by thephysician without requiring the physician to divert his or her attentionfrom the medical procedure. Additionally, or alternatively, as alsodescribed in greater detail below, securing the second input device 210to the catheter shaft 118″ can facilitate single-handed operation of thesecond input device 210 during a medical procedure.

In general, the second input device 210 can include a user interface230, a wireless transmitter 250, and a housing 270 carrying the userinterface 230 and the wireless transmitter 250. The user interface 230can include one or more inputs 130 a″, 130 b″, 130 c″, 130 d″, and 130e″, which can be any one or more of the various different inputsdescribed herein. In use, the physician can depress or otherwise engagethe one or more inputs 130 a″, 130 b″, 130 c″, 130 d″, and 130 e″, andthe wireless transmitter 250 can be in communication with the userinterface 230 to send one or more navigation and/or control commands toa remote processor, such as the processing unit 112″, according to anyone or more of the various different methods described herein. Thus, forexample, the physician can manipulate the user interface 230 to send oneor more navigation and/or control commands to the processing unit 112″based on input options displayed on a portion of a graphical userinterface, such as the graphical user interface 116″, according to anyof the various different methods described herein.

The second input device 210 can be at least one of electrically andfluidically isolated from a handle 120″ and the catheter shaft 118″ tofacilitate, for example, robust operation of the second input device 210throughout the medical procedure, independent of the catheter 106″. Forexample, the housing 270 can define a volume, and the wirelesstransmitter 250 can be disposed within the volume defined by the housing270. The one or more inputs 130 a″, 130 b″, 130 c″, 130 d″, and 130 e″can be at least partially disposed outside of the volume defined by thehousing 270 such that the one or more inputs 130 a″, 130 b″, 130 c″, 130d″, 130 e″ form at least a portion of an outer surface of the secondinput device 210 and are accessible by the physician. In certaininstances, the volume defined by the housing 270 can be substantiallyresistant to fluid ingress such that the wireless transmitter 250 isprotected from fluid that may contact the second input device 210 duringa medical procedure. Additionally, or alternatively, the one or moreinputs 130 a″, 130 b″, 130 c″, 130 d″, 130 e″ can be arranged relativeto the housing 270 to reduce the likelihood of fluid ingress into thevolume defined by the housing 270.

In certain implementations, the housing 270 can be securable to an outercircumference of the catheter shaft 118″ with the user interface 230partially constrained in at least one direction relative to the cathetershaft 118″. Such constrained movement of the user interface 230 relativeto the catheter shaft 118″ can, for example, facilitate locating theuser interface 230 by the physician during a medical procedure. That is,given that the user interface 230 is at least partially constrained inat least one direction relative to the catheter shaft 118″, thephysician can find the user interface 230 by moving his or her handalong the catheter shaft 118″ to find the user interface 230. Thus, thecatheter shaft 118″ itself can act as a guide for the physician, whichcan reduce the need for the physician to divert his or her attentionaway from the graphical user interface 116″ to find the user interface230 of the second input device 210.

As an example, with the housing 270 secured to the outer circumferenceof the catheter shaft 118″, the user interface 230 can be at leastpartially constrained in a radial direction relative to the cathetershaft 118″. As used herein, partial constraint in the radial directioncan include movement of less than about 2 cm (e.g., less than about 1cm) and, therefore, can include complete constraint in the radialdirection. In certain implementations, the user interface 230 can bemovable along an axis defined by the catheter shaft 118″ and, thus,partial constraint in the radial direction can include radial movementsufficient to allow the housing 270 and the user interface 230 to movealong the axis defined by the catheter shaft 118″. It should beappreciated that, in such implementations in which the housing 270 andthe user interface 230 are movable along the axis defined by thecatheter shaft 118″, the housing 270 and the user interface 230 can bemovable between the handle 120″ of the catheter 106″ and a sheath at theinsertion site of the catheter 106″ into the patient.

Additionally, or alternatively, the housing 270 can be securable in afixed axial position relative to the catheter shaft 118″. For example,an interference fit between the outer circumference of the cathetershaft 118″ and the housing 270 can hold the housing 270 in a fixed axialposition relative to the catheter 118″ during a medical procedure. Thefixed axial position can be any of various different axial positionsalong the catheter shaft 118″. For example, the housing 270 can besecured to a proximal end region 124″ of the catheter shaft 118″ withthe housing 270 extending distal to the handle 120″ of the catheter106″. Additionally, or alternatively, the housing 270 can be secured tothe proximal end region 124 of the catheter shaft 118″ such that thehousing 270 is adjacent to the handle 120″.

With the housing 270 at least partially constrained in at least onedirection relative to the catheter shaft 118″, the user interface 230can be rotatable about the catheter shaft 118″ and, optionally,rotatable about the handle 120″ coupled to the catheter shaft 118″. Forexample, the user interface 230 can be rotatable about an axis ofrotation coaxial with an axis defined by the catheter shaft 118″ (e.g.,freely rotatable 360 degrees about the axis of rotation such that theuser interface 230 is rotatable through multiple revolutions about theaxis of rotation). Rotation of this type can facilitate, for example,single-handed operation of the second input device 210 by the physician.That is, the physician can rotate the user interface 230 as necessary toalign the user interface 230 in a desired radial orientation.

The housing 270 can be at least partially formed of a materialcompatible with sterilization (e.g., any of the various differentsterilization techniques described herein) and, in some instances, thehousing 270 can be sterilized prior to being secured to the cathetershaft 118″. Additionally, or alternatively, the second input device 210can include a cover enclosing the housing 270 and the user interface230, and the cover can be formed of a material compatible withsterilization such as any of the various sterilization techniquesdescribed herein. A cover separable from the housing 270 can be useful,for example, in implementations in which the housing 270 carries one ormore components (e.g., batteries) that are not readily compatible withsterilization. In such instances, the cover can be sterilized apart fromthe second input device 210 and then used to cover the second inputdevice 210 prior to securing the second input device 210 to the cathetershaft 118″.

In general, the housing 270 can be securable to the catheter shaft 118″without the use of tools. The ability to secure the housing 270 to thecatheter shaft 118″ in this way can for example, facilitate securing thehousing 270 to the catheter shaft 118″ by the physician or other medicalpersonnel in the sterile field.

As an example, the housing 270 can include a first section 272 and asecond section 274, each defining a portion (e.g., substantially half)of a recess 276. The first section 272 and the second section 274 can bereleasably engageable with one another to position the recess 276 aboutat least a portion of an outer circumference of the catheter shaft 118″.The releasable engagement between the first section 272 and the secondsection 274 can be achieved through an interference fit between matingfeatures of the first section 272 and the second section 274. Further,or instead, the first section 272 can include a first material and thesecond section 274 can include a second material magnetically attractedto the first material such that placing the first section 272 and thesecond section 274 in proximity to one another results in coupling thefirst section 272 to the second section 274 through the magnetic forcebetween the first material and the second material.

In certain instances, the first section 272 and the second section 274can be coupled to one another at a hinge 278 pivotable to move the firstsection 272 and the second section 274 in a clamshell arrangement intoengagement with each other to position the recess 276 about the cathetershaft 118″. The hinge 278 can be useful, for example, for accounting formanufacturing tolerances associated with the outer circumference of thecatheter shaft 118″. Additionally, or alternatively, the hinge 278 canbe useful for reducing the number of parts needed to be manipulated bythe physician or other medical personnel in the sterile field to securethe second input device 210 to the catheter shaft 118″.

As an additional, or alternative, example, the housing 270 can include aclip defining the recess 276 and positionable about at least a portionof the outer circumference of the catheter shaft 118″. For example, theclip may be “U-shaped” such that the recess 276 is defined by legs thatare movable away from one another to accept the catheter shaft 118″ andbiased back toward one another to hold the second input device 210 aboutthe outer circumference of the catheter shaft 118″.

The recess 276 can be sized, for example, to fit about a standardcatheter size such that the second input device 210 can be securable toany of various different catheters of a given standard catheter size,including catheters made by different manufacturers. Additionally, oralternatively, the recess 276 can be sized to account for manufacturingtolerances associated with a given standard catheter size.

With the housing 270 secured to the outer circumference of the cathetershaft 118″, the user interface 230 can be suitable for single-handedoperation by the physician during a medical procedure. Suchsingle-handed operation can facilitate, for example, simultaneous orsubstantially simultaneous operation of the user interface 230 with onehand while the physician holds the catheter shaft 118″ or the handle120″ with the other hand. Additionally, or alternatively, the remotecommunication device 210 can be secured to the outer circumference ofthe catheter shaft 118″ at a position distal to an articulationcontroller 128″ of the catheter 106″. The articulation controller 128″can be, for example, any of the various different articulationcontrollers described herein to modify a distal end region 126″ of thecatheter shaft 118″. In certain implementations, the physician canoperate the articulation controller 128″ with one hand whilesimultaneously or substantially simultaneously operating the userinterface 230 with the other hand.

In general, with the housing 270 secured to the outer circumference ofthe catheter shaft 118″, the one or more inputs 130 a″, 130 b″, 130 c″,130 d″, 130 e″ can be arranged relative to the catheter shaft 118″ suchthat manipulation of the one or more inputs 130 a″, 130 b″, 130 c″, 130d″, 130 e″ does not cause unintended movement of the housing 270relative to the catheter shaft 118″. For example, the one or more inputs130 a″, 130 b″, 130 c″, 130 d″, 130 e″ of the user interface 230 can beany of the various different inputs described herein and can bedepressible or otherwise engageable in a direction parallel to the atleast one partially constrained direction of the user interface 230 suchthat the constrained movement of the user interface 230 can counter theforce exerted on the one or more inputs 130 a″, 130 b″, 130 c″, 130 d″,and 130 e″ and, thus, restricts undesired movement of the second inputdevice 210 as one or more inputs are received. Additionally, oralternatively, in implementations in which the user interface 230 isrotatable about an axis defined by the catheter shaft 118″, the one ormore inputs 130 a″, 130 b″, 130 c″, 130 d″, 130 e″ can be depressible ina direction transverse to the axis of rotation of the user interface 230such that providing an input is less likely to result in inadvertentrotation of the user interface 230 about the catheter shaft 118″. Itshould be appreciated from these examples that such an arrangement offorces can facilitate single-handed operation of the second input device210. That is, the physician can use a single hand to depress the one ormore inputs 130 a″, 130 b″, 130 c″, 130 d″, 130 e″ without requiring theuse of a second hand to hold the user interface 230 in place as input isprovided at the one or more inputs 130 a″, 130 b″, 130 c, 130 d″, 130e″.

In certain implementations, the second input device 210 can furtherinclude a power source 280 carried by the housing 270 and in electricalcommunication with the wireless transmitter 250 to power the wirelesstransmitter 250. The power source 280 can be for example one or morebatteries. Additionally, or alternatively, the power source 280 can bereleasably coupled to the housing to facilitate replacement orrecharging of the power source 280 (e.g., during or in between medicalprocedures).

In some implementations, the second input device 210 can further includea processor 282 in communication with the user interface 230 and thewireless transmitter 250. For example, the processor 282 can receive asignal from the one or more inputs 130 a″, 130 b″, 130 c″, 130 d″, 130e″ and send a corresponding signal to the wireless transmitter 250 fortransmission. In addition to, or instead of, the processor 282, thesecond input device 210 can include circuitry to receive a signal fromthe one or more inputs 130 a″, 130 b″, 130 c″, 130 d″, 130 e″ and send acorresponding signal to the wireless transmitter 250.

While second input devices have been described as including housingsthat can be clamped onto a shaft of a catheter, other implementationsare additionally or alternatively possible. For example, a second inputdevice can include a housing through which a distal end region of acatheter can be moved. Through such movement of the distal end region ofthe catheter through the housing, the second device can be disposedabout a shaft of the catheter. Thus, in certain implementations, thedistal end region of the catheter can be introduced into a patientthrough the housing of the second input device. For example, the housingof the second input device can include an introducer sheathpositionable, as is known in the art, in vasculature of the patient andthrough which the distal end region of the catheter can be introducedinto the vasculature of the patient during a procedure. Additionally, oralternatively, the housing of the second input device can include aninsertion sleeve positionable relative to the introducer sheath, as isalso known in the art. In use, the distal end region of the catheter canbe moved through the insertion sleeve and into vasculature of thepatient via an introducer sheath positioned in the vasculature of thepatient.

While second input devices have been described as being hand operated,other implementations are additionally or alternatively possible. Forexample, a second input device can include a foot pedal operable by thephysician tapping one or more inputs on the foot pedal to navigatethrough a second portion of a graphical user interface according to oneor more of the methods described herein.

While second input devices have been described as being physical devicesmanipulated by the physician, other implementations are additionally oralternatively possible. For example, a second input device can beimplemented through a virtual reality system (such as Leap Motionavailable from Leap Motion, Inc. of San Francisco, Calif.). In such animplementation, a physician's hand or hands can interact with a virtualreality environment to navigate and provide inputs to the second portionof the graphical user interface according to any one or more of themethods described herein.

While second input devices have been described as being operated withone or more of a physician's limbs, other implementations areadditionally or alternatively possible. For example, the second inputdevice can be responsive to one or more voice commands (e.g., “up,”“down,” “right,” “left,” and “enter”) to navigate and provide inputs tothe second portion of the graphical user interface according to any oneor more of the methods described herein. Such a second input deviceresponsive to voice commands can, for example, reduce the need forseparate hardware in the sterile field with the physician.

The above systems, devices, methods, processes, and the like may berealized in hardware, software, or any combination of these suitable fora particular application. The hardware may include a general-purposecomputer and/or dedicated computing device. This includes realization inone or more microprocessors, microcontrollers, embeddedmicrocontrollers, programmable digital signal processors or otherprogrammable devices or processing circuitry, along with internal and/orexternal memory. This may also, or instead, include one or moreapplication specific integrated circuits, programmable gate arrays,programmable array logic components, or any other device or devices thatmay be configured to process electronic signals.

It will further be appreciated that a realization of the processes ordevices described above may include computer-executable code createdusing a structured programming language such as C, an object orientedprogramming language such as C++, or any other high-level or low levelprogramming language (including assembly languages, hardware descriptionlanguages, and database programming languages and technologies) that maybe stored, compiled or interpreted to run on one of the above devices,as well as heterogeneous combinations of processors, processorarchitectures, or combinations of different hardware and software. Inanother aspect, the methods may be embodied in systems that perform thesteps thereof, and may be distributed across devices in a number ofways. At the same time, processing may be distributed across devicessuch as the various systems described above, or all of the functionalitymay be integrated into a dedicated, standalone device or other hardware.In another aspect, means for performing the steps associated with theprocesses described above may include any of the hardware and/orsoftware described above. All such permutations and combinations areintended to fall within the scope of the present disclosure.

Embodiments disclosed herein may include computer program productscomprising computer-executable code or computer-usable code that, whenexecuting on one or more computing devices, performs any and/or all ofthe steps thereof. The code may be stored in a non-transitory fashion ina computer memory, which may be a memory from which the program executes(such as random access memory associated with a processor), or a storagedevice such as a disk drive, flash memory or any other optical,electromagnetic, magnetic, infrared or other device or combination ofdevices.

In another aspect, any of the systems and methods described above may beembodied in any suitable transmission or propagation medium carryingcomputer-executable code and/or any inputs or outputs from same.

The method steps of the implementations described herein are intended toinclude any suitable method of causing such method steps to beperformed, consistent with the patentability of the following claims,unless a different meaning is expressly provided or otherwise clear fromthe context. So, for example performing the step of X includes anysuitable method for causing another party such as a remote user, aremote processing resource (e.g., a server or cloud computer) or amachine to perform the step of X. Similarly, performing steps X, Y and Zmay include any method of directing or controlling any combination ofsuch other individuals or resources to perform steps X, Y and Z toobtain the benefit of such steps. Thus, method steps of theimplementations described herein are intended to include any suitablemethod of causing one or more other parties or entities to perform thesteps, consistent with the patentability of the following claims, unlessa different meaning is expressly provided or otherwise clear from thecontext. Such parties or entities need not be under the direction orcontrol of any other party or entity, and need not be located within aparticular jurisdiction.

It should further be appreciated that the methods above are provided byway of example. Absent an explicit indication to the contrary, thedisclosed steps may be modified, supplemented, omitted, and/orre-ordered without departing from the scope of this disclosure.

It will be appreciated that the methods and systems described above areset forth by way of example and not of limitation. Numerous variations,additions, omissions, and other modifications will be apparent to one ofordinary skill in the art. In addition, the order or presentation ofmethod steps in the description and drawings above is not intended torequire this order of performing the recited steps unless a particularorder is expressly required or otherwise clear from the context. Thus,while particular embodiments have been shown and described, it will beapparent to those skilled in the art that various changes andmodifications in form and details may be made therein without departingfrom the spirit and scope of this disclosure and are intended to form apart of the invention as defined by the following claims.

1-20. (canceled)
 21. A method, comprising: receiving a signal indicativeof location of an ablation catheter in a chamber of a heart of apatient; at the same time, displaying— a graphical representation of thechamber of the on a first portion of a graphical user interface (GUI),wherein the graphical representation is based on the received locationsignal from the ablation catheter; on the first portion of the GUI, afirst set of input options responsive to an input command from a firstinput device; and on a second portion of the GUI separate from the firstportion of the GUI, a second set of input options responsive to an inputcommand from a second input device separate from the first input device;receiving, from the first input device, a first input command based onthe first set of input options; receiving, from the second input device,a second input command based on the second set of input options; andmodifying the displayed graphical representation in the first portion ofthe GUI between a baseline configuration and a modified configurationbased on (a) the first input command and (b) the second input command.22. The method of claim 21 wherein, in the modified configuration, asize of the displayed second set of input options is greater than a sizeof the displayed first set of input options.
 23. The method of claim 21wherein an opacity of the displayed first set of input options isgreater in the modified configuration than in the baselineconfiguration.
 24. The method of claim 21 wherein a position of thedisplayed second set of input options relative to the displayed firstset of input options on the GUI is different in the modifiedconfiguration than in the baseline configuration.
 25. The method ofclaim 21 wherein modifying the displayed graphical representation in thefirst portion of the GUI further comprises modifying the displayedgraphical representation based on an order in which the first inputcommand and the second input command are received.
 26. The method ofclaim 21, further comprising modifying the displayed graphicalrepresentation by adjusting an orientation of a view of the displayedgraphical representation of the chamber of the heart of the patient. 27.The method of claim 26 wherein modifying the displayed graphicalrepresentation includes modifying a pose of the displayed graphicalrepresentation in the first portion of the GUI.
 28. The method of claim21 wherein at least some of the second set of input options are the sameas some of the first set of input options.
 29. The method of claim 21wherein the second input device is operated by a physician, and whereinthe second set of input options is a subset of the first set of inputoptions.
 30. The method of claim 21 wherein the first input device is acomputer operated by a technician outside of a sterile field.
 31. Acatheter, comprising: a catheter shaft having a proximal end region anda distal end region; a handle portion carried by the proximal end regionof the catheter shaft; an articulation controller supported on thehandle portion, wherein the articulation controller is in mechanicalcommunication with the catheter shaft to selectively modify a positionof the distal end region of the catheter shaft; and a graphical userinterface (GUI) controller coupled to the handle portion and disposedrelative to the articulation controller along the handle portion suchthat a clinician can maintain the distal end region of the catheter inplace while manipulating the GUI controller.
 32. The catheter of claim31 wherein the GUI controller is configured for communication with adisplayed graphical representation of at least a portion of the catheteron a GUI.
 33. The catheter of claim 31 wherein the GUI controller isdisposed relative to the articulation controller along the handleportion such that the clinician can manipulate the GUI controller andthe articulation controller via one-handed operation.
 34. The catheterof claim 31 wherein the GUI controller is disposed relative to thearticulation controller along the handle portion such that the cliniciancan manipulate the GUI controller and the articulation controller usingthe same grip of the handle portion.
 35. The catheter of claim 31wherein the GUI controller is removably coupled to the handle portion.36. The catheter of claim 31 wherein the GUI controller is rotatablycoupled to the handle portion such that the GUI controller is rotatableabout an axis defined by the catheter shaft.
 37. The catheter of claim36 wherein the GUI controller is rotatable about 180 degrees of acircumference of the catheter shaft.
 38. The catheter of claim 36wherein the GUI controller is freely rotatable about a circumference ofthe catheter shaft.
 39. The catheter of claim 31 wherein the GUIcontroller comprises discrete navigation inputs including right, left,up, and down navigation inputs positioned separate from one another. 40.The catheter of claim 31 wherein the GUI controller is sterilizable.